Finding A Breastfeeding Support Person

from Dr. Jack Newman

Finding a Lactation Consultant or breastfeeding-support person may seem like a daunting task but it is well worth the effort. First, a few things to know:

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La Leche League is an international group of women who give mother-to-mother peer support. They are a wonderful resource for support and information and run support groups in cities all around the world. http://www.lalecheleague.org/

La Leche League Canada
Mother to mother information and support by phone & email
Community Groups for pregnant and nursing mothers.
Website information and publications for families and health professionals....


Lactation Consultants are International Board Certified Lactation Consultants this means they are registered Lactation Consultants, IBCLC, RLC who are required to keep current with breastfeeding information and must recertify every five years. We provide hands-on clinical support and are trained to work with all breastfeeding-related problems. In order to certify we must have many thousands of hours of practical hands-on training and must have completed many education credits to write the international exam in the first place.

To find a Lactation Consultant, contact http://www.ilca.org/ for a worldwide search or IBLCE http://www.iblce.org/international%20registry.htm or your local Lactation Consultant association: or, in Canada, the Canadian Lactation Consultants Association is also a good resource: http://www.clca-accl.ca/. In the USA, http://www.uslcaonline.org/

Breastfeeding Clinics may be found in many hospitals. Most clinics are staffed by IBCLCs, though not always.

Of course, getting the best start is the way to go, and having as few interventions during labour and delivery will help a mother to get that best start. Having a Midwife and/or Doula as support during labour is usually a good assurance that the labour will go as naturally as possible.

Midwives: though experts in pregnancy and labour support, they are also trained to counsel mothers in getting a good breastfeeding start.

In Ontario: Association of Ontario midwives: www.aom.on.ca (“find a midwife” function).
In Canada: Canadian Association of Midwives: www.canadianmidwives.org

Doulas may also be trained in breastfeeding support. A Doula is a labour-support person. Doulas may be found through DONA at http://www.dona.org or through CAPPA at http://www.cappa.net or in Canada: http://www.cappacanada.ca .


HOW TO CHOOSE A GOOD and HELPFUL BREASTFEEDING-SUPPORT PERSON

1. When you seek help from a Lactation Consultant (LC), you should not feel that she is mainly trying to rent or sell you some product. The Lactation Consultant is there to help you with your breastfeeding problem, and very often help does not require any products. Even if you do need to rent a pump, for example, you should not feel that the lactation consultant is focussing on sales or rentals. Certainly, if she does sell you a pump or product, this sale time should not be included in her hourly fee.

2. No matter what your problem, a good LC should not be telling you that you cannot breastfeed. We hear of some Lactation Consultants and doctors telling mothers they cannot breastfeed. Do not believe them. If you have nipples you can breastfeed. Women are often told they must stop or interrupt breastfeeding due to illness or a medication they are taking or a test they must undergo--this is only very rarely true. See handouts You Should Continue Breastfeeding 1 and 2.

3. No LC or breastfeeding-support person should ever bring formula with her to your home. LCs are not allowed to distribute formula samples or recommend a formula by name. Ask her ahead of time if she intends to bring some formula samples with her. This may be an indication of her true support for breastfeeding.

4. Nipple shields and bottles are being used much too often to try to fix breastfeeding problems, even though they can, very occasionally, be useful. Nipple shields should never be used for the baby who refuses to latch on before the mother's milk 'comes in' on day three or four (or sometimes later). Once the milk 'comes in', many babies will latch on easily without a nipple shield. There are usually better ways of supplementing or feeding babies than using a bottle. Be sceptical if you LC is quick to use a nipple shield. Patience, perseverance, and good technique are almost always good enough to get any baby latched. See handout When Baby Refuses To Latch On.

5. REMEMBER to Get the best Start: Try to ensure and aim for the most natural labour possible. A good Midwife or Doula may be an invaluable way to achieve that goal.

BE WARY IF:

1. You are told to feed x number of minutes per side
•Babies can feed well being on the breast short periods of time, and can feed poorly being on the breast all day
•Timing is meaningless and tells us nothing about what the baby is actually getting and whether or not it is enough

2. You are told to feed x number of times per day

•A baby who feeds well 6 times a day is better off than a baby who feeds poorly 12 times a day
•There are no studies to support the claim that a baby must feed 8-12 x/24 hour period. None whatsoever.

3. You are told to wake the baby every x number of hours

•A baby who feeds well will wake up when he's ready; if a baby feeds so poorly that he won't wake up on his own, there is no point in waking him up so he feeds poorly more times a day; the point is to get the baby feeding well.

4. Your breastfeeding-support person weighs the baby before and after each feeding

•What does this tell us? Even if the scales could be relied on as always accurate—so what? A 15 gm gain, for example, may mean baby consumed 15 mls of breastmilk—but what kind of breastmilk? 10 am breastmilk? 3pm breastmilk? Tuesday’s breastmilk? The beginning of the feeding breastmilk? The end? What? Ensure baby is actually drinking instead of just sucking, and follow our Protocol to Increase Intake of Breastmilk. Watch the video clips at www.drjacknewman.com. That’s how you will know baby has had enough.
•Test weighs have been known to show many false negatives. See Handout Is my Baby Getting Enough?

5. Your breastfeeding-support person tells you that sore nipples are normal and you need to endure it, or that your nipples need to “toughen” up or that your skin is overly sensitive, or, if you are a red-head, that you are supposed to have overly-sensitive nipples

•A good latch prevents and fixes sore nipples
•Pain that endures for many weeks may mean there is something else going on—please see a Lactation Consultant to get this checked out
•Nipple shields are not usually an appropriate remedy for sore nipples
•Skin colour is irrelevant

6. Your breastfeeding support person asks you to finger feed after you breastfeed your baby

•If a baby needs supplementation then that baby should be supplemented at the breast as long as the baby is latching. Finger feeding is not an appropriate method of feeding a latching baby. See Handout Finger and Cup Feeding

How Much Should An IBCLC Charge For A Home Visit?

There really is no set rate for IBCLCs and the fees for home visits range dramatically. In Toronto, there are some support people doing home visits for $35/hr and some going as high as $180/hr. Please do not let price fool you—the most expensive IBCLC is not necessarily the best. Do a little home work and research and ask her over the phone about some of the points listed above. An average rate is probably around $100/150 for a visit lasting around 2 hours. This may seem excessive but it is not—keep in mind that a good IBCLC will save you money in the long run by keeping you and baby breastfeeding and off expensive formula.

Questions?

First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.

Breastfeeding—Starting Out Right

www.drjacknewman.com

Breastfeeding is the natural, physiologic way of feeding infants and young children, and human milk is the milk made specifically for human infants. Formulas made from cow’s milk or soybeans (most formulas, even “designer formulas”) are only superficially similar, and advertising which states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to ensure breastfeeding is a happy experience for both mother and baby.

The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for about six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in too many health care institutions and make breastfeeding difficult, even impossible, for too many mothers and babies. For breastfeeding to be well and properly established, a good start in the early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.

The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has more difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole that is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn’t. Too many people who should know better just don’t know what a good latch is. Here are a few ways breastfeeding can be made easy:

1. A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being "helped" by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be sceptical, and ask for help from someone else who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open mouth wide—pause—close mouth type of suck). See also the website www.thebirthden.com/Newman.html for videos on how to latch a baby on (as well as other videos). If you and the baby are leaving hospital not knowing this, get experienced help quickly (see handout When Latching). Some staff in the hospital will tell mothers that if the breastfeeding is painful, the latch is not good (usually true), so that the mother should take the baby off and latch him on again. This is not a good idea. The pain usually settles, and the latch should be fixed on the other side or at the next feeding. Taking the baby off the breast and latching him on again and again only multiplies the pain and the damage.

2. The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother’s abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who "self-attach" run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator (see section on skin to skin contact). Incidentally, many babies do not latch on and breastfeeding during this time. Generally, this is not a problem, and there is no harm in waiting for the baby to start breastfeeding. The skin to skin contact is good for the baby and the mother even if the baby does not latch on.

3. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods.
Health facilities that have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is that the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ "observation."

There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up. If the mother is shown how to feed the baby while both are lying down side by side, the mother is better rested.

The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.

4. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is normally producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, the baby will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Note, it is not the baby who is confused. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5, Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?

5. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby’s latch, and use compression to get the baby more milk (handout #15, Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

6. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and thus get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but often supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid at the breast (see handout #5), not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with 5% sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.

7. Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula. It is very effective, and it is unethical marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. "But I need formula because the baby is not getting enough!" Maybe, but, more likely, you weren’t given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.

Under some circumstances, it may be impossible to start breastfeeding early. However, most “medical reasons” (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)

Handout #1. Breastfeeding—Starting Out Right. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005