Posts Tagged ‘IBCLC’
Lactation consultants claim that their services are required in very few cases when breastfeeding presents a complex problem – premature infants, infants born with abnormalities, or when mothers suffer from diseases that interfere with breastfeeding. The reality of IBCLC education requirements does not fulfill the promise to prepare an IBCLC to deal with most of these complex issues. The basic general education requirements historically did not lay the foundation to deal with complicated pathology in either infant, or the mother. The new 2012 general education requirements mimic requisites for a nursing degree, but severely lack in pathology physiology theory and hands-on training. Lactation education (theory) hours was bloated to 90 hours instead of 45. Clinical hours requirement varies from 300 to 1000 hours depending on the pathway to certification. Suggested venues to acquire clinical experience are hospitals, clinics, birthing centers, medical practices, public health departments, and mother support counselor organizations.
Taking into consideration that breastfeeding is a very practical skill, clinical skills should be very important, especially when helping women and infants whose experiences lie outside the norm. The requirement of clinical hours looks good on paper. In reality, in every single setting except the hospital one would be hard pressed to encounter enough abnormalities and pathologies to develop any clinically significant level of expertise lactation consultants claim they should be able to handle. Even at an average hospital an average postpartum floor a chance at dealing with pathology and abnormality is infrequent. The most common pathology clinicians at hospitals encounter is prematurity. To have access to a wide variety of pathology in both mothers and infants a lactation consultant would have to be trained at a teaching hospital affiliated with a medical school. To my knowledge, few, if any, lactation education programs offer this type of experience to develop entry level-expertise at the level declared by IBCLC certification.
Then lies the issue of developing the expertise further and continuously sustaining it. Again, this is only possible for selected few lactation consultants who have access to a relatively large number of pathological cases on a regular basis. An average lactation consultant in a hospital setting encounters an estimate of 85-95% of cases that require no technical or medical expertise of any kind. Psychological or counseling skills are all that is needed in the vast majority of cases with breastfeeding. One would think that advanced counseling, not medicalized technical skills would be placed higher in the context of this fact.
As of 2012 it is entirely possible to have virtually no clinical hands-on experience in helping mothers and infants with pathologies, pass the exam, and claim that you are qualified to handle complex cases that lie outside the norm. From an informal survey of IBCLC candidates in 2011 it was clear that even 10 years of experience in the capacity of lactation consultant does not guarantee any kind of broad expertise in breastfeeding help, even in routine normal cases. Majority of hospital based IBCLCs deal with a very small number of problems that women usually encounter in the first two days at the hospital. Often, there is no breastfeeding at the breast, but breastpump expression. Most hospitals do not report whether the infant was put to the breast or was receiving a bottle with expressed milk in their official statistics, although hospital records at times do contain this information.
The number one pathology some hospital IBCLCs are somewhat prepared to deal with is prematurity. This expertise is acquired on the job, it does not come from any training that most IBCLCs receive prior to sitting for the exam. Non-hospital based IBCLCs usually have no access to premature infants to gain the experience. IBCLCs who have not been trained through mother support groups typically have very limited knowledge of breastfeeding past 6 weeks, the time frame when most mothers seek IBCLC help.
Medicalization of breastfeeding is a grave concern of a small number of lactation consultants who have had first hand experience in nursing their babies, mother-to-mother support, and lactation consultant model to know the difference.
A long-time IBCLC bears witness to what professionalization of breastfeeding help has possibly done:
Yes, I’m alarmed. I see little erosions that simply didn’t exist 30 years ago. Specialized pillows; a rigidly horizontal baby; the cross-cradle hold (which I contributed to – sigh); blankets; a public that no longer gives nursing mothers dirty looks but actually chastises them; non-latching babies; exclusive pumping that’s called breastfeeding; the loss of the word nursing (which I also contributed to); the shifting of ownership from mother to professional; phenomenally difficult beginnings; utterly outrageous births that render women passive enough to accept all of the above… It’s not pretty.
When I chalk up IBCLC failings, though, the list is mighty long.
- Birth slid away on our watch, and we did nothing.
- We haven’t directly tackled the formula industry in any way.
- We introduced RAM, the cross-cradle hold, checklists, and a whole lot of other stuff that we’re now throwing out.
- We reinforce product over process.
- We continue to move the field toward medicine and away from a mother-baby relationship approach.
- We’ve set ourselves up as experts, even though we’ve been wrong about as much as we’ve been right.
- There sure seem to be more non-latching babies now than there were 25 years ago, and I think more sore nipples.
- We’ve contributed to the shriveling of LLL, the biggest, best-known mother-to-mother group in the world, or at least we’ve done nothing to support and promote it.
- In the US, the 6 month rate didn’t return to its 1985 level until about 1997, and the gap between initiation and the 6 month rate hasn’t changed (the gap was narrowest before we existed. Lawrence, pp 19 and 20)
- In the US, the rate of increase in breastfeeding initiation and duration has slacked off in recent years, despite an increase in the number of IBCLCs. As someone pointed out, the wider the gap between initiation and duration, the more disappointed mothers it represents.
I would like to express my deep gratitude to the above mention breastfeeding advocate who took time to think critically about the implications of professional breastfeeding support and allowed me to share her thoughts with the public.
Medicalization of breastfeeding is a hot new subject in sociological, anthropological, and nursing research. What do lactation consultants or professional literature say on the subject?
Jan Riordan and Karen Wambach in their “Breastfeeding and Human Lactation”, 4th edition, one the main texts for lactation consultant training, are mum on the subject. However, the previous edition of the book suggested:
“…lest we follow that conflicted path that led to the medicalization of childbirth, we must listen to voices that warn of the danger of lactation consultant medicalizing infant feeding…” (Preface, p.xxi)
Ruth Lawrence in her ” Breastfeeding: A Guide for the Medical Profession”, 7th edition informs of research by Rima Apple:
“…commercialization and medicalization of infant care established an environment that made artificial feeding not only acceptable to many mothers but also natural and necessary” (p.10)
Judith Lauwers and Anna Swisher in “Counseling the Nursing Mother: A Lactation Consultant’s Guide”, 5th edition sum up analysis of health service support of breastfeeding and note that medicalization of breastfeeding is on the five emergent themes. Wide availability of breast pumps contribute to medicalization of breastfeeding. Authors suggest that:
“It is incumbent on all who work directly with families to be a part of a solution in protecting breastfeeding, not part of the problem” (p.248)
They also warn lactation consultants
“…to be careful not to promote pumping and other gadgets to the detriment of breastfeeding”. (p.508)
Lesser known works that you have to look for researching medicalization of breastfeeding specifically are the following.
Chris Mulford in her article “Is breastfeeding really invisible, or did the health care system just choose not to notice it?” succinctly stated:
“As we work to ensure that the health care system provides good breastfeeding care, we need to guard against letting the medicalization of infant feeding keep us from remembering that breastfeeding is something that mothers and children do, in all the aspects of their private and public lives.”
Marina Green in “The History of the Medicalization of Infant Feeding” writes:
“The biomedical model contributes to the medicalization of breastfeeding and limits understanding of breastfeeding and support of breastfeeding women. Important questions remain about the professionalization of breastfeeding support through the development of the ‘profession’ of lactation consulting and the role of nursing as a profession and nurses as individual practitioners in the medicalization of breastfeeding.”
The question of medicalization of breastfeeding by healthcare workers such as lactation consultants is out there. There are warnings against it. There is very little information about the exact features of medicalization in professional literature. There is a call to listen to those who warn against it. There is also extreme resistance from lactation consultants to listen about medicalization of breastfeeding as reported by people who research and present on this issue (including myself).