Wednesday, May 11, 2011

What's in a name?

I thought a lot about the name for my blog. Granted, it was far less time than it has taken me to get around to actually creating a blog, but while it’s true that I often ruminate over minor decisions, this one felt pretty significant. I have been an IBCLC (International Board Certified Lactation Consultant) for fifteen years. I debated for almost a year before I made the decision to sit the exam and become board certified. I was already helping thousands of women breastfeed. I was a La Leche League Leader—completely committed to mother-to-mother support and coordinated a very successful inner city peer counseling program.  I was passionately opposed to the medicalization of mothering in all aspects of birth and parenting. I did not want to be a part of the problem and considered long and hard whether I could avoid that fate if I took the step to become a lactation professional.

In the end, I decided to become certified because, while working in hospital I saw how quickly the medicalization of birth was overtaking infant feeding. As birth has become more interventive, infant feeding has become more and more complicated for more and more mothers. And, there’s more than birth intervention in play. As the environment has become more toxic, as women struggle with infertility, hormone imbalances (such as hypothyroidism and PCOS), and as more and more women enter childbearing at a nutritional deficit, infant feeding has taken an even bigger hit.

We used to tell women that only a tiny percentage of women cannot produce enough milk for their babies, that breastfeeding doesn’t hurt so long as the baby is positioned correctly, that very few babies are bothered by foods their mothers consume, that tongue-tie is very rare, that breastfeeding takes a little practice and a lot of support, but that most women can succeed quite easily.

To be honest, that’s pretty much what I used to see as a La Leche League Leader. But, for the past 15 years, that has no longer been my experience. Cultural attitudes, poor science that has directed the focus away from breastfeeding and toward the product of lactation, intensive marketing by pharmaceutical companies of every manner of breastmilk substitute, the wildly and often repeated myths that fly through cyberspace and the ratcheting up of interventions in birth have changed the entire scenario. Breastfeeding in most of the Western world is not easy. Women need help. Really, really good help. So, I became an IBCLC.

Let me pause for a moment to explain something about that. IBCLC is an international certification, so it is identical throughout the world. That actually makes it pretty unique. An MD, an RN, a DO and many other health care providers cannot simply cross international borders and practice in their professions. Often, they require a different bit of training to come into line with the educational requirements in the new country. Since the IBCLC is conferred based upon the same guidelines everywhere, moving from one location to another does not require different evaluation or education. It might be true that a given country does not allow an IBCLC to practice without certain other guidelines being met, but that has nothing to do with the criteria met to become an IBCLC. So, when you hire an IBCLC, you are hiring someone whose prerequisites are to have met a certain set of educational criteria and spent thousands of hours working with breastfeeding mothers prior to passing an exam. For this reason, only an IBCLC should be referred to as a “lactation consultant“ (LC).

There is a lot of confusion around this topic, though and for the most part mothers are caught up ion the confusion without even knowing it. Sometimes, in their lack of understanding of the highly specialized education required to be a competent lactation consultant, health care providers have thought to expand their own knowledge base so as to be more helpful to their clients. Usually, such education is very limited and cannot be relied upon to support more than the simplest breastfeeding problems. In other cases, once it becomes clear to various administrators that having some kind of lactation specialist on their staff might be beneficial to their marketing strategies, many hospitals, clinics and physicians offices pay for staff members to receive breastfeeding training which typically consists of a weekend or week long program.

The problem is you don’t know what you don’t know. If a nurse or doula, for example, has taken a week-long course in breastfeeding, she knows an awful lot more than she did before. She can help a lot more moms than she could before. On the other hand, if she has no idea how complex a problem might become, she can easily have a false sense of her own skills, and have a poor sense of when she might need to refer elsewhere. To be honest, I think it also becomes awkward to promote yourself or your staff member as the “breastfeeding expert” or “breastfeeding specialist”, only to find yourself having to explain why your expertise is not sufficient. In the end, too few women receive the level of skill they need from their “lactation consultant”.

And, consider this. If you have had a hospital birth, chances today are pretty good you saw someone in your hospital who identified herself as being a “breastfeeding specialist” of some kind. She may have called herself a lactation consultant. Whether that person is an IBCLC, you may never know. Usually, you would never know to ask. I have had hundreds of moms tell me they “saw the LC in the hospital” and when I find out the person’s name, I discover that the person is not an LC at all. Alas, we as humans can be a little quirky about being “taken”. Often, in our embarrassment, we are angry at the person who told us, rather than the person who misled us.

But, this is what happens when you see someone who does not have adequate skills to assist you. Since you believe you saw an LC, you are not inclined to see another. After all, aren’t we all the same? It is especially challenging to consider that you may well have to pay out of pocket to see the credentialed LC, when the person you can see at your doctor’s office or hospital is free. It can be very difficult to imagine that there is such a significant difference that the fee is warranted.

You don’t know what you don’t know can apply just as easily to IBCLCs. For example, if you work in the hospital or clinic setting and have limited access to long-term feedback from mothers, you may well suggest strategies that are outdated or ineffective, but since you have no way of knowing this, you continue giving the same advice. Certainly, this is not always the case, but my advice is this: just as you would not assume every practitioner in any other field has the same experience and expertise, do not assume it of LCs either. And just as you would get a second opinion if someone could not help you if you had an injury, a toothache, a strange rattling noise under the hood of your car or a broken pipe in your house, please consider that your breastfeeding relationship deserves at least that much effort. While I agree that it should not have to be this complicated, and it should not be your problem, the reality is that this is how it is right now and the best you can do is learn to navigate the myriad of initials and help others do the same.

Basically, if a breastfeeding specialist has any initials other than IBCLC, her role is likely to be that of educator and support person, not clinician. The skills are very beneficial when you are hiring a birth or post-partum doula or midwife, when you are a choosing a physican’s office, when offered assistance at a WIC office or clinic. It means that the practitioner has enough interest in the relevance of breastfeeding to her role that she has chosen to spend time and money to be a better resource to her clients. But, part of the value of that additional education is her ability to establish pretty quickly when you might need more skilled intervention and to refer accordingly.

On my blog I could have used the term lactation consultant, but I decided I needed to be really clear that the initials IBCLC stand for something that I think parents have a right and a need to understand. My hope is that you will come to think of LC as synonymous with IBCLC and understand the differences as I have described above. 

Here’s the last piece. The “holistic” piece of my blog name. I personally practice in a way that has been informed as much by the path of my own life as by any education I have pursued. I have been living and raising my children holistically for 25 years and have incorporated all that I have learned in those years into my practice. For me, this is where the passion, the joy and the intellectual fulfillment enters my work. There is nothing more rewarding to me than to help a momma who has a breastfeeding problem such as mastitis, thrush, pain, or a poorly growing baby avoid the common interventions that typically only address symptoms and can wreak havoc with her gut and immune system, while gently exposing her to a new way of thinking about healing and well-being. When I work with moms over a period of years through my support network (Intuitive Parenting Network) and witness the ways they learn and integrate holistic practices into their own lives, changing the paradigm in which they raise their children and care for themselves and their families, I know that this approach is both needed and valued. I believe we, as mothers, value the wisdom, the knowledge and the skill that allows us to be competent and self-reliant caregivers.

As an LC, and as a mentor in holistic parenting, I am more concerned than ever about medicalization of the normal processes that fill our daily, ordinary lives. More interventions, more drugs and more control does not make for healthier, happy, more productive lives. I think, if anything, it immobilizes us and makes us impotent. That’s one reason why I am so sensitive to the idea that a lactation consultant, another “specialist” has to be much more than someone who simply intervenes and fixes your problems.

While I think mothers learn best from other mothers and truly need and deserve loving support, we live in a culture where breastfeeding isn’t easy and finding the resources that build our confidence in becoming the caretakers of our own families is difficult to come by. Practicing as a holistic IBCLC is my way of assuring that mothers receive expert care while having access to a far broader spectrum of knowledge, options, skills and support than is typically associated with a lactation consultant. It is my intention that in providing access to these resources, I offer mothers a new set of tools, tools that build confidence through competency and allow them to find grace in the problems they have encountered and overcome.

So, Holistic IBCLC it is.


  1. Jennifer, you are the epitome of a holisitc IBCLC and I am proud to be your colleague. Beautiful blog post...hopefully awareness will spread!

  2. So thrilled you're joining the blogosphere at last!

    Interestingly, I just happened to have this open in another tab:

    Very apropos to the varying levels of lactation training, I think. I may post on this as well.

  3. Very well put, Jennifer - great blog!

  4. Enjoyed reading every word and cheered, fist in air, through it. Well written, Jennifer! I always look forward to your contributions.

  5. This is coming to me at a great time, as I am looking to take a new direction in my career life, looking to do exactly what you are doing, and am needing support, and inspiration, and an example to follow. I teach high school art and English to 'at-risk' kids, but find so much frustration being around young, teen moms who have either no role models or dangerous examples to follow as they embark on the mothering journey themselves. I want to be of service to them and help expose them to holistic worlds of mothering practices, which are ways totally foreign to them. Thanks for going public on the internet. Because you have done so, a doula friend of mine (knowing what avenues of service I want to explore) found you and shared you with me; the interconnectedness of us all via the web can be so life-giving! Thank you for sharing! Many blessings...