Friday, November 2, 2012

The Pacifier Question

I can't tell you how many times I've been working with a new parent when they sheepishly tell me that their baby uses a pacifier. Often it's an admission they don't even want to make, assuming lactation consultants are intensely anti-pacifier, or worse, that using one means they're failing as parents.

So I want to take this opportunity to officially state that I am in no way against the use of pacifiers! What's more, I want to dispell the myth that lactation consultants believe that all of baby's sucking needs should be taken care of at the breast and that mothers who use a fake nipple aren't "doing it right."

I can see no reason why a baby who is breastfeeding well and gaining weight shouldn't be given a pacifier for non-nutritive sucking. Babies, especially very young babies, have an inherent need to suck. It's very comforting to them, and it doesn't always indicate a need to eat. Babies who have gastroesophageal reflux (GER) often benefit from sucking on a pacifier between feedings, and there is sound research that suggests that pacifier use may reduce the risk of SIDS.

Regarding feelings of "ineffective parenting," I would encourage you to relax and ground yourself in reality. While new mothers are often hyper-pressured to exceed attachment parenting guidelines in meeting their baby's needs, allowing your body to be baby's pacifier simply may not be appropriate for your lifestyle. For one, many mothers experience severe nipple pain/trauma from non-nutritive sucking (sucking without making a milk transfer). Others simply cannot be there to meet their babies' sucking needs 24/7. There is no reason to feel guilty about using a pacifier to calm your baby when you can't be there to do so yourself; while parenting certainly requires a high amount of selflessness, you're not going to be able to be an effective caregiver if you've given away all of your personhood in the first year of your baby's life!

On the other side, mothers are often told that acting as baby's pacifier will "spoil" them and impede their independence. This is also a completely unfounded notion; there is absolutely no evidence that responding to a baby's needs on demand will in any way contribute to an unhealthy dependence on their mother. If a mother has no nipple pain, then there is no reason not to forgo the pacifier for more breast time if it fits into mom's lifestyle and desires.

My only recommendation for pacifier use is that parents wait at least three weeks before introducing them or any other artificial teat (unless supplementation with a bottle is indicated, as directed by a lactation consultant). I recommend this for several reasons. For one, I want parents to learn how to read their babies' cues. Are they hungry, or do they just need to suck on something? This learning tends to take several weeks as parents adjust to having a new baby around. Secondly, the first two weeks after birth is critical in establishing mother's milk supply for the long term. If the delicate dance of supply and demand is interrupted by early pacifier use, mom's supply could suffer. Lastly, while true "nipple confusion" is rare, I do like to see babies demonstrate that they have gotten the hang of breastfeeding (generally, they get back to their birth weight in two or three weeks) before putting anything else in their mouths. This is especially true for babies who for whatever reason were slow to start or had any difficulty getting a grasp on feeding from the breast (pun totally intended).

Using a pacifier for your baby's non-nutritive sucking needs is nothing to be ashamed of or worried about. As a parent, you are capable of making the best decisions for you and your baby, and so long as your baby is nursing well and gaining weight, there is no reason to avoid pacifiers if you wish to use one.

Thursday, November 1, 2012

Breastfeeding Credentials, At A Glance

You know those letters after a doula's name that don't necessarily have to do with being a doula? Often those are credentials from different (but related) organizations and may indicate a specialty in a number of birthy areas: childbirth education, massage and bodywork, breastfeeding support, placenta encapsulation, nursing, etc.

There are many credentials that revolve around lactation, which can often be confusing when an already-exhausted family is searching for the right kind of support. Each of the below certifications qualifies one to offer a certain level of breastfeeding support, however, the IBCLC is the only credential that is qualified to provide clinical assessments and address the full scope of lactation challenges.

The following list lays out what each certification means, how one certifies, and the scope of practice associated with each.
IBCLC - International Board Certified Lactation Consultant - This is a clinical credential that requires 1000+ hours of required study, education and training culminating in a once per year international exam given by IBLCE. IBCLCs must recertify every 5 years, and every 10 must retake the exam. These clinicians work in hospitals, birth centers, out of their homes, and in private practices. They perform complete evaluations and assessments of both mother and infant and create individual plans of care, working hands on with all breastfeeding challenges as well as more complex health issues.

RLC - Registered Lactation Consultant - This credential is used in conjunction with IBCLC within the United States.

CLE - Certified Lactation Educator - CLEs have completed a 20-hour course on breastfeeding support and completed approximately 25 additional hours of out-of-class coursework which culminates in a certificate of completion from CAPPA. CLEs are trained to teach breastfeeding classes and answer basic breastfeeding questions, however, they must refer out to IBCLC for more complex cases and are not trained for hands on consults.

CLC - Certified Lactation Counselor - CLCs have completed a 45 hour course of education, culminating in a certificate of completion, sometimes after completing an end-of-course exam, from The Center for Breastfeeding. They are trained to counsel on normal breastfeeding situations and troubleshoot minor challenges, however, they must refer out to an IBCLC for more complex cases and are not trained for hands-on consults.

CLS - Certified Lactation Specialist - Similar to CLC, CLSs certify through Lactation Education Consultants by attending a 45-hour course and completing an end-of-course exam. They are trained to educate, support, and counsel mothers on normal breastfeeding situations, however, are not qualified to perform hands-on consults or administer clinical plans of care.

BEC - Breastfeeding Educator Certification - Those who hold a BEC have completed an intensive course of study with Birth Arts International. Prospective BECs complete a lengthy in-classroom or self-study course on the science of lactation, anatomy and physiology, pedagogy, sociology, medical terminology, and counseling. They must also complete 600 hours of supervised lactation support in varying clinical settings in their communities.  The BEC certification is community-specific and qualifies students to teach, support, and educate the public on breastfeeding and related issues and policies.

BC - Breastfeeding Counselor - A relatively new organization, Breastfeeding USA certifies mothers to lead free, highly accessible support groups for breastfeeding mothers. They answer questions regarding normal breastfeeding situations, offer tips for troubleshooting challenges, and refer out to IBCLC support when indicated.

LLLL - La Leche League Leader - La Leche League International is the oldest breastfeeding support organization in the country, now offering support groups all over the world. LLL leaders receive a multitude of training in normal breastfeeding situations, offering tips for troubleshooting challenges, and know when to refer out to IBCLC support. Offers mom to mom support in a casual and accessible environment. Many IBCLCs started as LLL Leaders.

WIC Certified Breastfeeding Peer Counselor - WIC CBPCs are employed by state WIC offices and provide support to breastfeeding mothers who qualify for WIC at no additional cost. While the requirements vary state by state, WIC Peer Counselors are mothers who have breastfed themselves and have completed comprehensive study in breastfeeding management, counseling, cultural diversity, and education.