What is a Lactation Consultant?
During my fourteen years of professional experience, I’ve been called a “Boob Fairy”, a “Dairy Dance Coach”, a “Lactation Lifesaver” and other fun names coined by my wonderful and inspiring clients. My official title is International Board Certified Lactation Consultant (IBCLC) and it is my goal and passion to help parents achieve their own unique infant feeding goals.
The IBCLC certification is recognized as the gold standard for health care professionals working with nursing parents. Becoming an IBCLC requires at least one thousand hours of clinical and community work before sitting the rigorous four hour examination. Additional prerequisites include fourteen university level health science courses, as well as 95 hours of lactation specific education.
In practice, supporting parents with their feeding goals means that every day looks completely different. I see mothers in clinic, at home, and virtually to prepare them for their feeding experience and support them with any challenges when the baby arrives. These challenges include helping mothers with sore nipples and breasts, blocked ducts and breast infections, low milk supply, how to pump and offer baby supplements, how to smoothly move back into the workforce while still nursing, weaning a nursing baby, and much more.
What to expect during your visit with a lactation consultant
During in clinic visits, tongue ties can be released and medications can be prescribed if necessary. While clinic visits are wonderful, home visits are really the ultimate way to receive feeding support. Seeing parents in their own environment can be very helpful. Siblings, pets, and the general energy of the home can make a difference to feedings. We are also able to organize feedings when the baby is displaying the behaviour that parents are most concerned with. The popularity of virtual visits has increased since March 2020 and the onset of the global pandemic. Adding ongoing virtual support has allowed me to reach a greater population of mothers in need. I have worked with mothers as far away as Spain and London. Working with varying time zones can mean very early mornings and very late nights, but it is so worth it when parents get the specialized support they need.
Latching - The Key to Nursing Success
Every clinic, home, or virtual visit includes working on latch mechanics. Positioning, timing, and rhythm are all a part of the breastfeeding process (which is why the term “Dairy Dance Coach” was used). As a team, mother and baby work together to create a deep, pain-free latch. As a lactation consultant, I have many “dances”, or latches, up my sleeve that can be used to help a mother reach her goals.
Personally, I will always remember my first time latching my second child, Mabel. While my old faithful latch (cross cradle - a position where the baby is held with the arm opposite to the breast they are latching onto) worked well to latch her on the right side she would not latch on the left in that same position. She was extremely fussy, would cry, and when I could get her to latch it would be extremely painful for me. Mabel had been breech for over 37 weeks until she finally turned after an external cephalic version (ECV) guided by my midwife. She also had a very rapid birth. The reality was that she was very uncomfortable due to tightness in her neck and body. We switched her to the koala or straddle position (a position where the baby sits on the mother’s thigh and comes on to the breast like a baby koala in a seated position) and I instantly felt no pain! Mabel went on without fussing and drank very well. A cranial sacral therapist also helped with her neck and jaw issues, at which time she was able to latch on both the right and left breasts in many different positions. A different latch meant a different experience for both of us.
Lactation Tip - Latching
The latch is the key to nursing success! The aim when latching is to get the lower areola into the baby’s mouth and not the nipple. To that end, start with the nose in line with the nipple which encourages the baby to reach up for the breast. When the baby attaches to the breast, we should see a big reach between chin and chest. When looking down at the baby, their nose should be away from the breast and we should see the upper areola above the upper lip. If the latch you have been instructed to do is painful, be sure to get good help from an experienced IBCLC.
Oral Anatomy - It Really Matters
An experienced IBCLC will have the ability to assess infant oral anatomy for potential issues. The way that a baby latches onto the breast is important, but if they lack the function to take the nipple deeply and undulate the tongue with rhythm, it can lead to nipple pain and the inability to draw the milk out of the breast well. An IBCLC will assess for a tongue tie. A tongue tie is a condition where the piece of tissue, called the frenulum, that connects the base of the tongue to the base of the mouth, is unusually short, thick or tight. This can constrain not only the tongue, but mouth, neck and connected muscles as well. Often these ties need to be released so that the mother can reach her feeding goals.
While there is never a guarantee that resolving a tongue tie will immediately result in relief from breastfeeding challenges, I have personally seen some profound results. We saw a mom in our clinic that had previously been to the same lactation clinic 6 times. While they did look in the mouth, a posterior tongue tie went undiagnosed. The mother was in pain even when latching with a nipple shield, which is a piece of silicone shaped like a nipple that is placed over the breast. She had begun to pump and bottle feed when she saw us. As soon as I examined the baby’s tongue it became clear that it was the cause of the mother's pain. We released the tongue tie and the baby latched onto the breast and drank very well. Two weeks later, the mother reported that from that moment on, she went on to exclusively breastfed her little one.
Lactation Tip - Addressing a Painful Latch
If you feel a lactation consultant or doctor is pushing a nipple shield or is not helping to address the root cause of your pain, look elsewhere. If you continue to feel pain, feel that your baby is not getting enough at the breast, or is fussy and discontented at the breast, they may have tightness in their oral anatomy.
Beyond All Odds - There is Always Hope!
As an IBCLC, I have had the privilege to witness remarkable mothers who are determined to breastfeed and, beyond all odds, have succeeded. One mother in particular stands out. After multiple visits to a lactation clinic, she was told she should simply stop trying to take her baby to the breast. Her son was 12 weeks old and would turn away and get frustrated when presented with the breast. Early on he had required a bottle for supplementation and had become used to the fast flow of the bottle. Essentially the fast bottles had become to feel safe as bottle flow is immediate and consistent. For this reason, it is my advice to introduce bottles in a very paced manner. After our appointment, the mother worked hard to slow the bottle flow, which was very frustrating for her baby at first. We also offered the breast in a number of positions and used distraction to lessen his anxiety and uncertainty. After a month, her son had started to latch onto the breast and drink happily for short times for around half the feeds of the day. His mother described her feeling of success as euphoric and said her husband was amazed at her feeling of joy. With supportive, non-judgemental help and an understanding and empathy of the baby's experience we were able to help the mother reach her breastfeeding goals!
Lactation Tip - Bottle Feeding
The World Health Organization advises avoiding artificial nipples for the first four weeks of life or until breastfeeding is well established. Sometimes it is necessary to introduce a bottle earlier, so make sure to speak to your IBCLC for details on how to make the experience at the bottle as close to the experience at the breast as possible. Most importantly, it is key that a baby suckle on a dry nipple for a full minute before they get their milk (extra burping or farting can help with any gas). It can take 30-60 seconds for a baby to get a letdown at the breast, so they need that extra time to suckle at the bottle to mimic the flow of the breast.
Preparation is key
Reaching out to a lactation consultant before you give birth, or as soon as you feel you are having difficulties nursing, can be an important step to ensuring that you reach your feeding goals. Remember that these goals are different for every family and may change throughout the duration of your nursing experience. Nursing does not have to be all or nothing – there are so many beautiful moments in between. The ultimate goal is to ensure that when you look back to early parenthood, you feel that you enjoyed your baby and your feeding experience! Happy nursing!