Friday, May 10, 2013

Avoiding Mismanagement: Why you should see an IBCLC for lactation challenges

I cannot stress the number of times I've seen breastfeeding parents -- exhausted and at the end of their rope -- come into my office after perhaps weeks of troubleshooting and self-diagnosis. Often these are issues that, if caught early on and properly managed, would be fairly easy to fix. However, the delay between the onset of the problem and the point at which they arrive in my office often means the treatment will be longer and more involved.

We are very fortunate to have a wealth of breastfeeding resources. Not too long ago, new parents that struggled with breastfeeding literally had nowhere to turn, and the bottles of formula offered up by their pediatricians became necessary. Today, we have La Leche League, WIC Peer Counselors, and a variety of moms groups and doulas that specialize in breastfeeding support. While I cannot sing the praises of these resources loudly enough, occasionally a lactation challenge requires more than simple remedies and old wives' tales. And while La Leche League in particular has a protocol for referring parents to a qualified clinician, social mom's groups and meetups often do not.

A recent case in particular comes to mind. It was a first-time mother who had struggled from the beginning with a suppressed milk supply. She was hardly at risk for such a deficiency: healthy pregnancy, natural birth, and great support at home. But something -- for the life of me I could not figure what -- had thrown a wrench in the gears very early on.

So she sought advice from several very knowledgeable resources: her childbirth instructor, her doula, some friends, her mother, and the internet. But these remedies were to no avail, and by the time she got to me she was providing less than half of what her baby needed in breastmilk, the rest supplemented in formula.

It was truly this mother's determination to breastfeed her baby that got her through what had become a very serious milk supply issue. The individualized plan of care I provided combined with her willingness to do all the legwork brought her supply back to a level she felt good about, though I can't help but think she'd be off the supplement completely if I'd had the opportunity to work with her sooner.

Again I want to emphasize the appreciation I have for lactation-knowledgable support persons, be they nurses, doulas, childbirth educators, friends, etc. Time and time again this support -- and lots of it -- keeps new parents focused on achieving their infant feeding goals even in the face of difficult roadblocks. However, what has inspired me to sit here and write this today is my observation that sometimes these support resources keep parents from seeking out clinical support when it's needed.

Why does this happen? I do not think anyone intends to keep a breastfeeding mother from seeking proper care. I think it's just that we all want to help. It's the nature of birth workers, of nurses, of care-giving family members, of friends... we see a problem, we want to help. And it is very difficult, especially for us doulas with multiple certifications, to admit an issue might be beyond our management capabilities.

I do wish to point out, however, that there are people out there who provide services that they are not appropriately credentialed to provide. There are a number of non-IBCLCs in particular that advertise "lactation consultation", and while they likely offer invaluable support to many new parents, they may very well be operating beyond their scope. This often creates the very delays I describe above.

I listed breastfeeding certifications in a post several months ago. I encourage you to check out what those letter combinations mean, and most importantly, check the scopes of practice for each.

Many doulas and childbirth educators in particular also have the CLE, CLC, or CLS credential. This makes them valuable support resources. Folks who hold these certifications are qualified to tell you when things are going well and when they are not, to offer support and encouragement, and to teach basic troubleshooting techniques. However, they are in no way qualified to provide clinical management of any major breastfeeding challenge.

Which brings me to my original point: the IBCLC is the only credential recognized the world over to provide proper clinical management of all breastfeeding challenges. Though even us IBCLCs refer to more advanced clinicians when necessary; sending a patient to her midwife or obstetrician for a fluconazole script comes to mind here.

A quick note on accessibility: it is true that lactation consultation from an IBCLC is more expensive than an assessment from a doula (and it's certainly more expensive than the free advice found on Google). You should be aware, however, that lactation consultation and supplies are now covered under most health insurance plans when it is provided by an IBCLC or higher. Most hospital-based clinics will file for you, and my private practice provides a form for reimbursement. I am fortunate to work as an IBCLC at Peaceful Beginnings of the Triad, a private practice small enough to make sure you see the same lactation consultant for each of your visits. We pride ourselves on following up with you personally and offering continuity of care. We also host a weekly Breastfeeding Clinic for minor challenges and reassurance.

In other words, when you seek the support of an IBCLC, not only do you receive care provided by someone who's qualified to provide it, your insurance is more likely to cover the visit. And when you get proper support at or near the onset of a problem, the challenge will be more easily overcome and require fewer appointments. It's a win-win, and the best way to ensure you and your little one are receiving the care you deserve.