Monday, June 18, 2012

Is your care provider really breastfeeding friendly?

Now for the Controversial…

There is a lot of talk these days about breastfeeding friendly care providers, who is the best HCP (health care provider) to go to – Dr., Nurse, Midwife, doula, CLC (Certified Lactation Counselor), CLE (Certified Lactation Educator), LLLL (La Leche League Leader), BC (Breastfeeding USA Breastfeeding Counselor), or  IBCLC (International Board Certified Lactation Consultant)?   How is a mom to know who the best help for her is with that alphabet soup and each of these professionals claiming to be able to help her?  It can be difficult to say the least.  

Many times our care providers mean well, but leave us confused or worse:  Un-helped and possibly harmed.   There is nothing like having your care provider say, “Just hang in there…it will get better!”  And all you want to know is how to make that piranha (who resembles your baby) stop causing you excruciating pain every time they want to eat!

We hear it all the time:  breastfeeding should be easy.  It truly should be ‘Put baby and breast together and let magic happen!’  I often tell moms, ”baby needs to ‘earn his keep’ so let’s see if he can,” while having mom lay back a bit, put baby on her bare chest and let him go find the breast, self-attach and nurse well.  If he does (with no pain to mom) – he has ‘earned his keep’ in that he gets a meal and mom didn’t have to do a thing.  If he doesn’t, I figure out why not.

Sadly, many HCP’s do not have the training they need to handle more complex cases, and rather than refer out immediately they ‘try to help’ (this includes IBCLC's, by the way).  While this is all nice in concept (especially if they are not charging the mom for the services – worse if they are), and the intent may be good and honorable, there absolutely is harm that can happen.  Many moms have stated to me that, while their care provider was very nice, they felt like guinea pigs so that person could learn more and get more experience.  Frankly, in my opinion, that's unethical.  We practitioners should NEVER use our clients as guinea pigs.  We should absolutely recognize when we are out of our area of expertise (or Scope of Practice) and refer out ASAP.  That being said, if there is no one in the area to refer out to (and this absolutely does happen), the care provider should be up front with the mom and state that she is in over her head but, since there is no one else to refer out to she will everything she can to find more information to help.

Far too many times over the years I and other colleagues around the world have been called in as the last resort to fix a train-wreck that could have been avoided if the other care-providers had referred out sooner.  And while we may have gotten very good at cleaning up those kinds of messes - we really don't want to have to do that.  There is nothing like that phone call of, “I’ve seen 2 midwives, 1 doula, 3 nurse practitioners and 4 LC’s already in the last 8 weeks.  If you can’t fix this, I’m done.”  No pressure there!   Many of us (who fix train wrecks for a living now) can spot the problems easily because we have a lot of training that others do not.  This does not make us better – it just makes us differently skilled.  And the others were well intentioned – at least we sure as heck hope so!  However, they really should know when they are in over their head and they should know that there are others out there who can step in and help them help their clients.  But, sadly, for whatever reasons, they don’t refer out and they don't give the client other options.  They just keep 'trying to help' while nothing is getting better and mom and baby suffer.

What is avoided when HCP’s do NOT try to do it all and rather, know their Scope of Practice and when to refer out?  Weeks of stress and frustration of not knowing why things aren’t working, anger, emotional stress, physical stress, pain, postpartum depression, and breastfeeding failure.  And what we all need to know as HCP's is that if we do not refer out to more experienced practitioners in a timely manner (when it is needed) WE can cause breastfeeding to fail – and that is OUR responsibility – not the mothers.  I have seen it far too many times myself personally - being called in to fix a train wreck that is now un-fixable because the other person trying to help did not refer out in a timely manner.  But - because 'they were so nice and did their best to help us!', couples do not seek to hold the other party accountable for their actions (or lack thereof).  And those people continue to inadvertently cause harm to many more mothers and babies.

So what is a mom to do?  First, when looking for Lactation care, start when you are pregnant.  Talk to local lactation professionals, make some calls, ask them about their experience, their education, and get referrals from other moms.  Do you 'click' with them?  Ask how long they have been in practice, do they stay current on new advances in lactation care, will they be available to you 7 days a week or not?   Do they do home visits, what do they charge, what services do they offer after the consult?  Ask your Dr.’s if they are supportive of breastfeeding and what will they do for you if you have breastfeeding challenges?  Ask your midwife, doula, CLC, CLE, LLLL, BC if they offer breastfeeding support and consults, and then question their education, their skills and if their Scope of Practice allows hands on consults (many do not!).  Most midwives, doulas, CLC’s, CLE’s, LLLL’s, and BC’s have perfectly fine basic breastfeeding skills, but many are not IBCLC’s and do not have the advanced training for more complex situations that do arise from time to time (even with natural, easy and home births).  Ask all of these care providers (including the IBCLC) if they have outside referrals for IBCLC’s and if they will refer you out if they cannot ‘fix’ a breastfeeding challenge easily and quickly (like within 1-2 visits).  If not, look for someone else who will.  

A skilled practitioner should be able to help you find the source of the problem in the first, or at least the 2nd, visit and give you a solid care plan on correcting that problem and getting you and baby back to breastfeeding.  If they are still trying to ‘figure it out’, ask for a referral to someone with more expertise.  A good practitioner will have already given you that referral making sure that you know they want the best care for you and right now they are not it – and that is OK.   I’ve been in practice for 17 years now and I consider myself a good practitioner.  I am a highly skilled and educated Lactation Consultant (IBCLC).  But I don’t know it all and I don’t claim to – there is no way I could know it all.  I know where my specialties lie – I know what I don’t know.  I have no problem referring out or consulting with others when needed to assist my clients.  I just cannot do it all and because I can’t, I have a highly skilled team of other care provider’s to back me up and help my clients.  

If you happen to be in the middle of a situation where you are having breastfeeding challenges that have gone on for weeks, you are frustrated and/or confused, your care provider has not given you a solid answer as to what the problem is (many moms find themselves going back week after week to said provider with no resolution) and your care provider has not referred you to someone with more expertise – ask for that referral or start talking to other moms in your community and looking for an IBCLC who can help you.  Don’t wait.  It shouldn’t take weeks of visits to figure out what the problem is and have a care plan to fix it.  It just shouldn’t.   

Trust your gut – if you don’t feel like you are getting appropriate help don’t stay with someone ‘because they are so nice’…Remember:  This is all about You and Your Baby - it isn't about them.  They are not the ones who are important - YOU are.  Ask for referrals and find someone who can help you solve the challenges once and for all and help you find normal breastfeeding once and for all.  It may not be easy, but it is worth it!