IBCLC: The Fixer?

Can someone "fix" breastfeeding? Sometimes it feels like that's what moms, nurses, and doctors expect from us. Ultimately we are educators, providing the tools and education needed to improve breastfeeding for both mom and baby. However, there is a line we cannot cross, a barrier with which we all struggle. Where is the boundary between helping and setting up false or inflated expectations? As healthcare providers become more acquainted with collaborating with IBCLCs and the unique skillset we bring, it is becoming more common to find ourselves working with people, including new parents, who believe we can fix issues only they or their baby can control.

My closest colleagues and I all believe in the power of establishing proper expectations for newborn behavior as being the foundation of teaching breastfeeding to both parents and medical staff. Our culture does not do this. Knowing that it is normal, safe, and healthy for infants to wake frequently can help new parents avoid the frustration and confusion that occurs when their baby does not sleep for 6 solid hours like many baby books imply or encourage. Understanding that individual infants feed for varying amounts of time at each feeding is useful when their baby has some 15-minute feeds and some 45-minute feeds. Seeing and hearing other parents model infant calming techniques helps them to follow their instincts and normalizes the act of responding to babies' cues. Without expectations appropriate for newborn humans, new parents sometimes expect their babies mostly to sleep and to need nothing other than sustenance in specific amounts at prescribed times, along with the occasional diaper change.

I am finding more and more frequently that I am spending time educating other healthcare providers in what they can expect from me as an IBCLC. I am aware that the profession has gained acceptance and grown to its current standing through the dedication, hard work, and advocacy of the first generations of credentialed consultants. They should be commended for their perseverance. The current reality is that we continue to fight that battle as well as the new one: unrealistic expectations of parents and medical staff with regard to supporting breastfeeding in a medical environment.

IBCLCs are, by nature, intense questioners in that every piece of information we receive about a breastfeeding situation makes us want more information about what happened before. It helps us to think forward to what can be done to improve things! When we dive backward into the breastfeeding issue, we often uncover one or more factors which are likely to have created the current situation, I.e. birth interventions, poor breastfeeding advice, or simply unrealistic expectations of newborn behavior. It's a basic tenet of counseling that you must listen, and the best way to create opportunities to listen is to ask open-ended questions. We don't just go into a new mother's room and ask "Is breastfeeding going ok?" That's actually the question I am there to answer. Hint: if it was going ok, I probably wouldn't have been referred to the patient in the first place. (When I am taking phone calls, I know it's not going ok because they called me!)

So where's the fixing come in? Well, to start, it's pretty common for a nurse to request one of us see a mother who has not been breastfeeding frequently since birth. Clearly that mother needs education on normal newborn feeding patterns, but she might also need better pain control, help positioning and/or attaching the baby, or something she can say when her visitors/ family members remark that she's "feeding that baby too much." In the end, between me and the nursing staff, we can provide any or all of those things, but if the mother does not want to feed the baby more frequently, she won't. Sometimes we are looking at a baby that clearly has not been latching well, based on the obvious nipple trauma we observe, but someone thinks we can "fix" it just by correcting the latch technique. Sorry, but I don't have a magic wand or potion to make that skin trauma heal instantly to make nursing more comfortable. I also do not have the power to "convince" a mom to breastfeed, but I am frequently asked to do just that. I am an educator! I provide information. I can do it all day, but at 3 hours postpartum, it's just not the right time to debate the evidence and talk about infant feeding choices. Exhausted new parents have limited learning capacity and even more limited patience for staff who seem to disagree with all their requests or opinions.

Most frustrating of all are the cases where baby has an obvious oral anatomy issue which is precluding effective breastfeeding OR a Late Preterm Infant without the stamina or buccal pads to breastfeed well, yet doctors and nurses are saying "Oh, just call Lactation. They'll help you get that baby breastfeeding!" Well, yes, I'd love to try - just remember our definitions of success are going to be very different as I educate the parents about the steps they will need to take to protect their potential for breastfeeding success over the critical first few weeks of establishing breastfeeding and milk supply. I want them to succeed and I have plenty of information to pave that path for them, but please don't set up a false sense of what is possible today given the baby's limitations.

We see more and more moms struggling with high Body Mass Index, various types of Diabetes, other hormonal medical conditions, and a veritable plethora of birth interventions, all shown to affect how breastfeeding works in the first few days of life. Yet somehow we are expected to "solve" breastfeeding problems. We don't solve anything in most cases - we provide hope that breastfeeding can work with time and patience and we provide education, techniques, and skills to protect baby's health and mom's milk supply in the meantime. There's no easy solution to preventing jaundice when a baby is born by vacuum extraction. There's no simple way to fix hypoglycemia in the large-for-gestational-age infant of a diabetic mother. There's no one-size-fits-all answer for a mom with a baby losing weight at 3 weeks of age. These and all breastfeeding problems require time and attention from a skilled clinician who looks at the whole picture, and they require a mother who is committed to breastfeeding. Absent that commitment, no true solution is possible. Let's keep our expectations real as we educate new parents and allow them the freedom to be as committed to breastfeeding as they choose to be.

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