The IBCLC Game Has Changed

An IBCLC returns from her first in-person lactation conference in 3 years with some thoughts

This game has changed. We have a much different - and bigger - job than we did even 10 years ago.

There’s so much today’s IBCLC needs to know how to do, especially if they are working outside of the hospital/birth experience.

{It’s funny to me that I’ve spent the past 8 years or so creating and elaborating upon a strategy to simplify what parents/mothers and babies are doing during The First 100 Hours of lactation, and what I am finding more and more now is that the complications beyond those first 4 days are expanding exponentially.} (←these brackets mean that I had this thought while writing this but probably should write more about it separately.)

When I studied and trained to become a lactation consultant, we were incredibly focused on feeding from the body. We learned about the relatively few tools, devices, and ointments/creams that were available, and we spent the vast majority of our time learning how to assess milk intake and milk production for dyads who were primarily or exclusively feeding from the breast/chest.

We learned about expressing milk for preterm babies, and that’s what the research studied. We didn’t think much about hand expression, and there were so few types of breast pumps that it was really possible to hold expertise on how each of them performed. At that point, we were still marveling at the thin silicone that had recently brought massive change to the utility of nipple shields as tools to bridge babies who couldn’t latch on the breast or who needed a bridge from early bottle feeding.

Speaking of bottles and nipples, there weren’t so many of those either, and they were fairly easy to distinguish from one another.

When gathered in groups, we talked about what we felt were the biggest contributors to the lactation issues we saw: the interference from birth interventions upon the establishment of early lactation, and the lack of research to support what we *knew* we were seeing in people whose milk production was insufficient for their babies. We wondered when we would get physicians to join us en masse in investigating low milk production, and we actually worried a bit that growing our numbers in the profession would be a challenge.

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If I’ve bored you with these tales of Lactation Before, please come back to me.

We’re talking about Lactation Now.

Today’s IBCLC needs to have a toolbox that is much bigger than my 2009 version. That is not so very long ago, yet it feels in some ways like it is an entire generation.

There are so many factors to call out in explanation here. Maybe I’ll leave that for a list next time.

What I really want to emphasize is that Lactation Now is an environment where we see a LOT more interference from societal barriers (racist systems, continued lack of standardized paid leave, implicit bias, etc.) that restrain our ability to increase breast/chestfeeding and human milk feeding rates. It’s an environment where the IBCLC needs to able to assess a lactation dyad and scenario which is much more likely to consist of a variety of feeding modes, multiple types of equipment for milk expression, feeding baby, and healing nipples, and routines of baby care and sleep that have been overlaid - from external influences - over the normal physiology of infant feeding.

It’s so complicated. Every dyad that reaches out for help is doing so many things and using so many things. This is what we comment on when we gather in groups professionally (most of the time that’s virtual, so there’s another change.) We don’t say this just as commentary - we are asking each other where in the world to find all of the different types of training and knowledge we need in order to meet these dyads where they are and help them make progress. We ask over and over where the research is. We question the motives and ethics of companies creating and promoting and marketing their devices and machines to our clients without research on their potential impacts.

Those of us who were doing this in the land of Lactation Before know that the skills we have to support feeding from the body are essential, necessary pieces of the puzzle that will always be needed - and indeed are more needed in any emergency or disaster situation when the devices and tools are no longer available.

Those of you who are streaming into this profession now, though, you can already see how needed the newer, expanded skillset is. You’ve been experiencing what it’s like to try to navigate lactation personally in this environment of new stuff and new options while attempting to rely on lactation professionals who are trying to keep up with the deluge of products.

You’re looking at a process of preparation, training, and studying for an exam which will test how much you know about the standards that have held steady throughout the few decades this profession has existed. And on top of that, you’re looking at a process of preparation, training, and learning about the rest of the skills you know you will need in the real world to support the types of complicated lactation scenarios you will encounter (and already do in your acquisition of clinical hours.)

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Like with any type of expertise, the more you learn, the more you realize you do not know. I definitely feel that. I do want to acknowledge, though, that there are absolutely areas we know more about than when I started.

We know a lot more about how babies actually latch, suckle, and transfer milk, partly due to the use of ultrasound to visualize it.

We understand and are able to have a positive impact on the facilitation of infant reflexes around feeding due to collaboration with many other disciplines.

We have more detailed and useful information about the composition of human milk, storing it, and what happens to it in different contexts.

We know more about mental health and how intricately intertwined it is with breastfeeding self-efficacy and ability to function.

Essentially, we have more detail about many of the things that we wondered about 20 years ago. Today we wonder about more things, and that’s a normal cycle that has repeated itself for as long as sentient beings walked the earth.

What is making our job as IBCLCs much more complicated is the proliferation of devices and tools. It is, at best, very hard to keep up with everything we might need to know to support dyads, and at worst, harmful in ways that have just not been studied.

Devices and tools are critical elements of managing lactation problems, and it’s wonderful to have them available when they are needed or wanted. The ethical question is the same as we have historically asked about infant formula: where is the justice if they are not universally high-quality, accessible to everyone, affordable or free,and subject to continual monitoring and updates for improvement…

I celebrate that electric breast pumps make it possible for people to exclusively express their milk - I really do. But is it right that it’s only possible for some people to acquire them, or any other lactation product or tool that has opened new doors? Once we start asking questions like that, we circle back around to the structural barriers again, and though they may look different in various countries and regions around the world, barriers to breastfeeding still persist everywhere. I simply happen to live in a place where parents are exposed to products constantly despite having extremely variable access to them, and that has become a barrier in itself in the place where I live and work.

Most of all, I worry about the profession of lactation care. I worry that as this need to expand the toolbox/skillset/knowledge base continues to grow (potentially exponentially as there seems to be no slowing of new products hitting the market), the capacity of the IBCLC will be outrun. We struggle already to manage compassion fatigue, personal mental and physical health impacts of the job we love, and the need for continual learning and growth. There are only so many hours in a day.

Is it perhaps time to specialize? I’m certainly not to first to ask this question when things shift, but I don’t know that I’ve heard or read much talk about this in relation to the use of lactation aids and tools. Is there a space opening up for some IBCLCs to be officially recognized or designated for their more detailed knowledge and capacity to help with devices and tools? What standard information about products and tools does the average/every IBCLC need to know today?

If you are having a lot of thoughts and emotions after reading this, you’re not alone. Writing this felt vulnerable and a bit wild for me. I hope you’ll let me know how you feel about it. We can only learn if we keep talking to each other and being really honest about it.