Lactation Consulting: Is it for you?

Abstract

Not so long ago, breast-feeding was thought of as an odd and embarrassing practice, and was not only discouraged but, in some states, outlawed in public. Mothers who wanted to breast-feed their infants received little support from health care professionals or from family members, and often had no knowledgeable, encouraging support person or group to turn to. During the past few years, perceptions about breast-feeding have changed dramatically. As a result of nutrition research and of the work of advocacy groups and professional associations such as The American Dietetic Association, the benefits of breast-feeding for mother and child are now widely accepted, and the number of mothers who initiate breast-feeding is dramatically higher. Yet, many of these mothers stop breast-feeding after a month or two, often because their instruction in how to breast-feed and how to deal with breast-feeding problems was inadequate or nonexistent, and they don’t know where to find help. Unfortunately, many of the potential health benefits for the infant are forfeited when breast-feeding is not sustained for several months. Thus, the thrust of breast-feeding activism is increasingly going beyond advocacy to education and support that will promote sustained breast-feeding for at least 6 months and, ideally, for up to a full year or longer. This change is reflected in the ADA position published on page 662 of this issue of the Journal, with its emphasis on communicating the importance of sustained breast-feeding for at least 12 months. A Desperate Need “Lactation consultants are desperately needed to help new mothers sustain their breast-feeding,” says Ginger Carney, RD, a certified lactation consultant at LeBonheur Children's Medical Center in Memphis, Tenn. “With support from the Surgeon General's Healthy People 2000((1)Healthy People. Department of Health, Education, and Welfare, Washington, DC1979Google Scholar), the rate of breast-feeding is slowly on the rise. Some hospitals in the nation are reporting a rate of up to 95% of women leaving the hospital breast-feeding, but at 2 weeks out, there is a significant drop-off. Lactation consultants can help mothers over initial problems or complications that may arise, so that breast-feeding can be continued until at least the first birthday.” “Most physicians recognize the value of breast-feeding,” says Amy Spangler, MSN, who is a certified lactation consultant and president of the International Lactation Consultant Association (ILCA), a professional organization for lactation consultants. “However, breast-feeding promotion in the absence of breast-feeding support reduces the likelihood of success. It is unrealistic to expect a primary care provider to spend an hour or more with a breast-feeding mother who is having difficulty getting her baby to latch on properly to the breast. The lactation consultant can do this.”“We have an entire generation of women with little or no breast-feeding experience to guide them. It will take several generations to restore the breast-feeding knowledge base. Will the day come when lactation consultant services are no longer needed? We hope so.” What is a Lactation Consultant? ILCA defines a lactation consultant as “a health care professional whose scope of practice is focused upon providing education and management to prevent and solve breast-feeding problems and to encourage a social environment that effectively supports the breast-feeding mother/infant dyad ((2)The Lactation Consultant. International Lactation Consultant Association, Raleigh, NC1997Google Scholar).” Lactation consultants function as members of the health care team to empower women to make informed infant feeding decisions, to assist women in learning the skills to successfully initiate and maintain lactation and overcome obstacles to breast-feeding, and to act as advocates for families who choose breast-feeding. “Years ago, new and expectant mothers looked to their grandmothers, mothers, and sisters for breast-feeding information and support. Today, we have an entire generation of women with little or no breast-feeding experience to guide them,” says Spangler. “It will take several generations to restore the breast-feeding knowledge base. Will the day come when lactation consultant services are no longer needed? We hope so. While lactation consultants will continue to be essential members of the health care team, fewer consultants will provide basic breast-feeding knowledge and support, and more will focus on professional education and management of complex challenges such as premature infants or infants with cleft lip or palate.” The Dietitian's Unique Perspective Dietetics professionals are uniquely positioned to support and encourage sustained breast-feeding, both among mothers and among other health care professionals. “The dietetics professional working in the perinatal field can significantly impact the rate of breast-feeding initiation and duration,” says Carney. “Because the dietitian is the primary promoter of optimal nutrition during the life cycle, it is only reasonable to expect the perinatal specialist to promote successful breast-feeding and the provision of breast milk to the infant and young child.” As a result of this unique relationship, lactation consulting is a career path being chosen more and more frequently by dietetics professionals. “Lactation consulting is a viable career opportunity for dietitians,” says Vergie Hughes, MS, RN, a certified lactation consultant who is director of Lactation Education Resources, a lactation consultant training program. Hughes says that while the majority of lactation consultants are nurses, an increasing number of dietetics professionals are joining their ranks. “Dietetics professionals possess unique expertise to enrich this field,” says Hughes, “especially their knowledge of the nutritional aspects of a mother's diet and the issues surrounding the adequacy of a mother's milk.” Spangler agrees. “Lactation consulting is a multidisciplinary field attracting nurses, dietitians, physicians, educators, and researchers. This diversity adds to the effectiveness of the support team,” she says. “Each individual brings different knowledge and skills to the field.” Training and Certification Several training opportunities are available for dietetics professionals seeking to increase their knowledge and skill level in the area of lactation consulting. Courses are offered on-site throughout the United States and in most other countries, and extension programs are also available. A list of training programs is included in the box on page 592, and additional information about training is available from ILCA, also listed. Although lactation consultants are not required by federal or state law to be certified, many pursue voluntary certification from the International Board of Lactation Consultant Examiners (IBLCE), which is the only lactation consultant certification program fully accredited by the National Commission for Certifying Agencies. A health care professional who is also an International Board Certified Lactation Consultant (IBCLC) may find recognition and career opportunities that are not available to others who have studied lactation but are not board certified. A growing number of positions are now designated for IBCLCs, and the IBCLC credential is increasingly recognized at a professional and government level and by health insurance companies. The IBLCE requires that candidates for certification meet defined eligibility criteria, including a combination of educational requirements and experience as a breast-feeding consultant, before being approved to sit for the annual certification exam. Certification as an IBCLC is for 5 years, and recertification by continuing education or reexamination is required (see box below). Carney believes lactation consultants should pursue certification if at all possible. “Mothers attempting to establish and preserve a breast-feeding relationship deserve to know who has the skills to help them do this,” she says. “The IBCLC is the credential that will identify the practitioner as an expert.” Brenda Lisi, MS, RD, a certified lactation consultant who works with the US Department of Agriculture in Alexandria, Va, decided to obtain certification after working with mothers and infants in WIC. “Dietetics professionals need additional education and training to be competent lactation consultants,” she says. “I decided to become certified for two reasons. First, I wanted to make sure I understood all the issues involved in breast-feeding advocacy and lactation management. I had not had experience in assessment of babies or mothers. Second, I knew the credential would help me be accepted as an expert in the circles I worked in. It says I am serious about my commitment.” Where Do Lactation Consultants Work? Lactation consultants work in a growing number of professional settings. According to a report from the IBLCE ((3)1997 IBLCE Background Information Packet. International Board of Lactation Consultant Examiners, Falls Church, Va1997Google Scholar), just over half of all lactation consultants work in a hospital. About one fourth are in private practice, and another 9% work in clinics. A small but growing number of lactation consultants work with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). “Breast-feeding advocate and lactation educator training programs are especially beneficial for WIC nutritionists,” says Sue Murvich, MS, RD, perinatal nutritionist and certified lactation consultant at Gundersen Lutheran Hospital in La Crosse, Wis. “In Wisconsin, we recently trained over 150 health professionals, most registered dietitians from WIC or hospitals, to become lactation educators.” Spangler says that governmental support is strong and growing for the promotion of breast-feeding among WIC constituents. Pediatric dietitians in particular have many opportunities to function as lactation consultants. “Pediatric dietitians already have the basic scientific knowledge of how to meet the needs of healthy infants and how to modify normal feedings to meet special requirements of sick infants,” says Carney. “Pediatric professionals should also possess the knowledge and know-how to explain to the mother how to establish or maintain her breast-feeding relationship with her infant so that optimal feeding may be provided. This expert is especially needed in an environment where illness of the mother or infant precludes normal, healthy, happy breast-feeding,” she continues. “Places such as a neonatal or pediatric intensive care unit, or even a level II nursery, can benefit from the knowledge and expertise of a pediatric dietitian trained in the field of lactation. Many infants are deprived of their own mother's milk because medical personnel do not know how to utilize expressed breast milk to meet the needs of a critically ill infant.”For More InformationContact the following organizations for additional information about lactation consulting.Professional affiliation:• ILCA, 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607; 919/787-4916; fax, 919/787-4916Training programs:• Breastfeeding Support Consultants Center for Lactation Education, 228Park Lane, Chalfont, PA 18914; 215/822-1281• Lactation Education Resources, 3621 Lido Place, Fairfax, VA 22031; 703/ 691-2069; fax, 703/691-2069• The Lactation Institute, 16430 Ventura Blvd, Suite 303, Encino, CA 91436; 818/995-1913• La Leche League International, 1400 N Meacham Rd, Schaumburg, IL60173; 847/519-7730; fax, 847/519-0035• UCLA Extension Lactation Consultant Training Program, 10995 LeConte Ave, Suite 315, Los Angeles, CA 90024-2883; 310/825-9187Certification:• IBLCE International Office, PO Box 2348, Falls Church, VA 22042-0348; 703/560-7330; fax, 703/560-7332 For More Information Contact the following organizations for additional information about lactation consulting. Professional affiliation: • ILCA, 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607; 919/787-4916; fax, 919/787-4916 Training programs: • Breastfeeding Support Consultants Center for Lactation Education, 228Park Lane, Chalfont, PA 18914; 215/822-1281 • Lactation Education Resources, 3621 Lido Place, Fairfax, VA 22031; 703/ 691-2069; fax, 703/691-2069 • The Lactation Institute, 16430 Ventura Blvd, Suite 303, Encino, CA 91436; 818/995-1913 • La Leche League International, 1400 N Meacham Rd, Schaumburg, IL60173; 847/519-7730; fax, 847/519-0035 • UCLA Extension Lactation Consultant Training Program, 10995 LeConte Ave, Suite 315, Los Angeles, CA 90024-2883; 310/825-9187 Certification: • IBLCE International Office, PO Box 2348, Falls Church, VA 22042-0348; 703/560-7330; fax, 703/560-7332 Needs and Opportunities No matter what the setting or whether or not a lactation consultant chooses to become certified, the need for knowledgeable breast-feeding advocates, educators, and counselors is tremendous. “All dietetics professionals need to be breast-feeding advocates, with or without credentialing,” says Murvich. “We should all promote and support breast-feeding as a healthful choice for mother and baby, especially beyond 3 months, when most of the health benefits are most effective. “Dietetics professionals working with maternal and child populations have a responsibility to keep up to date on nutrition during lactation and breast-feeding, and should know where to refer mothers for breast-feeding questions and problems beyond their expertise,” says Murvich. “Dietitians should also join local breast-feeding task forces to help with breast-feeding promotion, education, and legislation.” “We should also be advocates in our own professional environments,” Murvich adds. “Think how breast-feeding duration rates would climb if every dietitian's place of employment provided electric breast pumps, or at least a clean place for employees to pump. Breast-feeding should be a topic at state, regional, and national dietetic association meetings.” Concludes Carney, “It is vital that dietitians take a leading role in educating mothers and other health care professionals on the superiority of breast milk for infant nutrition and the importance of sustained breast-feeding for women, children, the future of the family, and the health of our world.”