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I come across this situation quite a lot, so it has inspired me to post this blogpost to facilitate a sense of understanding for us all. I cannot emphasise clearly enough, that this post is not a dig at any one health professional, but merely to provide understanding for all those parents that are frustrated by the misunderstandings.
More and more of the families I see are becoming increasingly frustrated because they have seen many Lactation Consultant's (or other health professionals) who they report have not been able to identify the causes of their infant's feeding issues such as lip tie, tongue tie, neck tightness due to in utero womb cramping, reflux etc... These frustrations are equally matched with the conflicting advice that parents receive when it comes to feeding their babies.
With advances in medical knowledge, it is increasingly difficult for health professionals to be skilled in knowing absolutely all there is to know about paediatrics, infant feeding and all associated variables. We have become more and more specialised in our area of expertise and this is what we do best.
Considering this, it is a well known fact, that not all health care professionals have equal knowledge and experience when it comes to these particular issues. And it's no-ones "fault", there is no one to "blame"...
Studies have clearly demonstrated that healthcare professionals receive anywhere between 30 minutes and 3 hours of breastfeeding education throughout their clinical preparation.
The terms International Board Certified Lactation Consultant (IBCLC's) and Lactation Consultant are used interchangeably which creates confusion for many reasons.
Anyone can call themselves a "Lactation Consultant" but not all can call themselves an 'IBCLC".
Here are just some of the differences.
Most IBCLC's identify themselves as a "Lactation Consultant" - could you imagine anyone understanding the difference between this and 'International Board Certified Lactation Consultant"?
A lactation consultant may have been an IBCLC in the past, but never practiced as one.
A lactation consultant may have been an IBCLC, but is not currently certified as one.
The two are literally not the same.
In some states in Australia, Child Health Nurses are Midwives and Midwifery studies are predominantly focused on prenatal and birth care with a small focus on postnatal care.
Breastfeeding education for Midwifery students is vastly improved these days - I am told they spend a minimum of one day's clinical experience with IBCLC'S and up to a few hours in lectures at University.
This is great, compared to the 10 minute crash course I got at University studying Midwifery and the mere 4 power point slides I was demonstrated during my Family & Child Health Nursing Course only 5 years ago.
Child Health Nursing courses may have optional subjects in breastfeeding and human lactation, but predominantly don't. The role of the Child Health Nurse is primarily focused on applying their amazing assessment skills to detect developmental and health issues in mothers, babies and their families. Their role is also focus on health promotion in prevention of health issues and risk reduction in young families.
INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT (IBCLC)
IBCLC's are required to be a recognised health professional:
Complete at least 90 hours of education in human lactation and breastfeeding within the 5 years immediately prior to applying for the exam.
This education must cover:elopment and Nutrition 26
Infant Development & Nutrition
1. Feeding behaviours at different ages
2. Food intolerances/allergies
3. Infant anatomy and anatomical/oral challenges 4. Introducing complementary foods
5. Low birth weight
6. Milk banking – formal and informal
7. Normal infant behaviours
8. Nutritional requirements - preterm
9. Preterm development and growth
10. Skin tone, muscle tone, reflexes
11. T erm development and growth
12. WHO growth charts with gestational age adjustment
Maternal Physiology & Nutrition
1. Breast development and growth
2. Breast surgery
3. Composition of human milk
4. Maternal anatomical challenges
5. Maternal nutritional status
6. Nipple structure and variations
Maternal Physiology & Endocrinology. Physiology and
3. Cleft lip and palate
4. Congenital anomalies (e.g., gastrointestinal, cardiac)
5. Gastroesophageal Reflux Disease (GERD), reflux
7. Infant acute disease (bacterial, viral, fungal, systemic)
8. Infant neurological disabilities
9. Small for Gestational Age (SGA), Large for Gestational Age (LGA)
2. Milk ejection reflex dysfunction
3. Maternal acute disease (bacterial, viral, fungal, systemic) 4. Maternal chronic disease
5. Maternal disability (physical and neurological)
7. Milk supply, low or over
8. Nipple and breast conditions
9. Nipple pain and trauma
10. Post-partum hemorrhage
11. Pre-eclampsia / pregnancy induced hypertension
Pharmacology and Toxicology
1. Alcohol and tobacco
3. Drugs of abuse
5. Gel dressings/nipple creams
6. Medication (prescription, over-the-counter, diagnostic and therapeutic
7. Medicinal Herbs
Psychology, Sociology, and Anthropology
1. Transition to parenthood
2. Birth practices
3. Foods to eat/avoid that affect lactation 4. Employment – returning to work
5. Family lifestyle
6. Identifying support networks
7. Maternal mental health
8. Maternal psychological/cognitive issues 9. Mother-baby relationship
10. Safe sleep
12. Cultural competency
1. Effective milk transfer (including medically-indicated supplementation)
2. First hour
4. Managing supply
5. Milk expression
7. Refusal of breast, bottle
8. Skin-to-skin (Kangaroo care)
Equipment and Technology
1. Feeding devices (e.g., tubes at breast, cups, syringes, teats)
2. Handling and storage of human milk
3. Nipple devices (e.g., shields, everters)
7. Communication technology
Education and Communication
1. Active listening
2. Anticipatory guidance
3. Care plan development and sharing
5. Educating mothers and families
6. Educating professionals, peers, and students 7. Extending the duration of breastfeeding
8. Emotional support
10. Group support
Ethical and Legal Issues
1. Breastfeeding in public
2. Clinical competencies
3. Code of Professional Conduct (CPC) 4. Principles of confidentiality
5. WHO code –advocacy and policy
1. Apply research in practice
2. Appraise and interpret research results
3. Use research to help develop policies and protocols
Public Health and Advocacy
1. Advocate for Baby-Friendly Hospital Initiative (BFHI)
2. Advocate for compliance with World Health Organization International
Code of Marketing of Breast milk Substitutes (WHO Code)
3. Advocate for mother / baby in healthcare system
4. Develop breastfeeding-related policies
IBCLC exam application fee is $940.04 AUD
-this does not include the costs involved for exam preparation
Recertification is required every 5 years
Limited - usually private practice in association with a paid employment as income often not drawn from private practice
Associated private IBCLC Costs:
Why pay for an IBCLC when you can get one for free?
Most maternity hospitals and local Child Health Centers provide breastfeeding support via their clinics.
Limitations apply to the care provided in these clinics. For starters, most hospitals require IBCLC's to be a Registered Nurse and Midwife, they also provide capped services whereby there are limits to when you are able to attend the clinic. Consultations are usually of 1 hour duration.
Breastfeeding clinics run via Child Health Centers are often run by Maternal & Child Health Nurses who are not required to be IBCLC's. Limitations that apply include needing to share your appointment time with several other mothers and one IBCLC. Lack of continuity of care is often an issue as well.
A few facts: