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Running head: THE ROLE OF A LACTATION CONSULTANT








The Role of a Lactation Consultant
Laurel Kaiser
Methodist College Of Nursing
Nursing 350









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Lactation consultants are a vital part of the healthcare system. Together with the rest of the healthcare team they make sure that mother and baby's care as a breastfeeding pair is complete. The International Board Certified Lactation Consultant represents the "gold standard" in lactation consultant credentialing. Lactation consultants who carry the credentials IBCLC behind their names are specially trained and qualified to assist with every aspect of breastfeeding. I chose the topic of lactation consulting because I feel strongly about being a breastfeeding advocate. I believe that those in the healthcare field, especially the people involved in woman’s health and pediatrics should be knowledgeable in this area. After all it has been found that breastmilk is the best source of nutrition for infants.
There many advantages to breastfeeding! Research shows that breastfed infants have fewer and shorter episodes of illness. The nutrition provided by breastmilk benefits the baby’s IQ. The skin-to-skin contact encouraged by breastfeeding offers babies greater emotional security and enhances bonding. Breastfeeding appears to reduce the risk of obesity and hypertension for the infant later in life. Breastfeeding delays the onset of hereditary allergic disease, and lowers the risk of developing allergic disease. Breastfeeding helps the baby’s immune system mature, protecting the baby in the meantime from viral, bacteria, and parasitic infections. Breastfeeding protects against developing chronic diseases such as: celiac disease, inflammatory bowel disease, asthma, and childhood cancers. (Shinskie and Lauwers, 2002)


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Breastfeeding is best for mom too. Increased levels of oxytocin stimulate postpartum uterine contractions, reducing blood loss and encouraging uterine contractions. From 3 months to 12 months postpartum, breastfeeding increases the rate of weight loss in most nursing mothers. Breastfeeding has even been found to lessen the severity of postpartum depression by keeping the hormonal levels more balanced. Breastfeeding also reduces the mother’s risk for breast cancer, cervical cancer, and osteoporosis, (Shinskie and Lauwers, 2002). It is important that the lactation consultant collaborate with the mother shortly after delivery to eliminate frustration and prevent the abandonment of breastfeeding. Collaboration ensures that the mom and baby start reaping the benefits of breastfeeding right from the start.
The definition of an International Board Certified Lactation Consultant (IBCLC)
is: “The allied health care provider who possesses the necessary skills, knowledge, and attitudes to facilitate breastfeeding. With a focus on preventive health care, she encourages self- care and parental decision- making prenatally and postnatally. In addition IBCLCs use a problem solving approach to provide appropriate information recommendations and referrals, in a variety of settings�(The International Board of Lactation Consultant Examiners, 2005). Lactation consultants can assist mothers in preparation for breastfeeding before baby arrives through the time the mother or her baby chooses to wean. Many times they serve as simply a source of information, encouragement, and reassurance that mother and baby are doing everything they should be. At other times, their extensive knowledge and hands-on assistance may be necessary

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to address a certain problem or difficulty the mother or baby may be having (E. Orr, personal communication, February 25, 2005).
A breastfeeding mother would find a lactation consultant's expertise extremely helpful in the following situations. First time mothers usually need help in positioning their infant at the breast. There are several different positions in which to breastfeed, and
the lactation consultant helps the mother find those which suit her and her baby. In the first two weeks positioning is especially important as the baby learns to become efficient at the breast. The mother will need guidance to be certain of a good position and latch so the baby feeds properly. The lactation consultant starts off by getting the mother comfortable in a sitting position, with as many pillows on hand as she will need. Putting the baby on the pillow or her lap, depending on how low her breasts are, and turning the baby in to face her lying on his side tummy to tummy. It is painful to breastfeed with the baby's head turned. When the baby is trying to latch on, the lactation consultant will have the mother guide the baby’s head to her. When the mother supports her breast, she needs to make sure her hands are away from the nipple and not obstructing the baby's latch. The positions in which a lactation consultant will instruct the mother to use are: the cradle hold, football hold, and side lying position (E. Orr, personal communication, March 8, 2005).
Lactation consultants must always be concerned about how the baby is latching on, because improper latch can cause very sore nipples and the baby may not receive enough milk. If the latch is correct there will be no sucking in or dimpling of the baby's cheeks. The baby should begin with fast, short sucks which stimulate the nipple. When
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the milk lets down the rhythm should change to slower, deeper sucks and swallowing should be heard. The jaw movement should go all the way to the baby's ears. “The lips should be flanged out and open wide. The bottom lip should cover most of the areola while the top lip covers a lesser degree of it� (Shinskie and Lauwers, 2002). One of the most important signs that the latch is correct is that it is comfortable for the mother and is not painful for her. To take the baby off the breast, or release the latch, the mother should insert her finger into the corner of her baby's mouth between the gums and break the suction. The mother should not attempt to pull the baby from her breast, as it is painful and can damage her nipples (E. Orr, personal communication, March 8, 2005).
Nipple pain can be extremely uncomfortable and is usually preventable. Lactation consultants can help mothers overcome sore nipples and correct improper latch on. If the mother’s nipples feel painfully sore or the nipples or areola feel bruised, it is likely that it is related to an improper latch-on process or ineffective sucking. Nipple pain should only occur (if at all) within the first few seconds of latch on and should not even occur at all after the first week. We can suspect a difficulty with baby's latch or sucking if the mother’s nipples become very red, raw, blistered, or cracked. A latch or sucking difficulty or a structural variation in the baby's mouth might result in nipples that look creased or turn white at the end of feedings. Some babies need to learn to open their mouth wider. Reinforcing the behavior does this. The lactation consultant will have the mother use her breast to gently tickle your baby’s lips and then wait for the baby to open wide (even if it takes a while). The mother quickly responds to the wide mouth by bringing the baby onto the breast. The lactation consultant would also recommend the

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use of lanolin cream on the mother’s sore nipples to help heal and soothe them. She would also recommend that the mother air dry her nipples after each feeding (E. Orr, personal communication, February 25, 2005).
Lactation consultants can also help diagnose babies who are tongue-tied. The medical term for this condition is known as "ankyloglossia" (Davies, Juanita, 2002). It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted. “Ankyloglossia may cause a heart- shaped appearance to the tip of the tongue and can interfere with breastfeeding if the baby is unable to extend his tongue. This can cause chronic nipple soreness and can make it difficult for the baby to stay latched on� (Shinskie and Lauwers, 2002). “Tongue-tie is congenital and hereditary. It occurs relatively often: between 0.2% and 2% of babies are born with tight frenulums� (Walker, 2002). If it is determined that ankyloglossia is causing breastfeeding difficulties, the lactation consultant will refer the baby to his pediatrician for a simple procedure called a frenetomy that can quickly correct the problem in a relatively painless outpatient procedure. The doctor simply clips the frenulum to loosen it and allow the tongue full range of motion. It takes less than a second, and because the frenulum contains almost no blood, there is usually only a drop or two of blood. The baby is put on the breast immediately following the procedure, and the bleeding stops almost right away (Walker, 2002).

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Lactation consultants usually spend a lot of their time helping mothers who have babies who are hard to wake up for feedings. There are several reasons why a baby might be hard to wake up for feedings. These reasons are: medications the mother received
during labor (narcotics or magnesium sulfate), a traumatic or prolonged birth, delayed first feedings, jaundice, and hypothermia (E. Orr, personal communication, February 25, 2005). The lactation consultant will educate the mother regarding how to rouse her baby. There are many ways to do this; loosening or removing baby’s blankets, changing the baby’s diaper, stimulating the baby by massage or gently rubbing his hands and feet, wiping the baby’s forehead and cheeks with a cool wet cloth and doing baby exercises by manipulating the baby’s arms and legs or by doing baby sit-ups. If the baby is having much difficulty waking up, sucking and latching on the lactation consultant will consider a technique of supplementation referred to as “tube feeding� (E. Orr, personal communication, February 15, 2005). This technique involves one side of a tube inserted into a bottle of formula or expressed breastmilk and the other side is inserted into the baby’s mouth at the breast or inserted into the baby’s mouth along with the mother’s finger. This rules out nipple confusion, because the way the baby has to suck is similar to breastfeeding. “Nipple confusion is a problem that arises when a breastfed baby is given an artificial (rubber or silicon) nipple and must try to learn to nurse both from his mother's breast and the bottle nipple. While seemingly similar, these two feeding methods require completely different mouth and tongue motions and swallowing skills� (Wilson-Clay, 2005).

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The lactation consultant also educates breastfeeding mothers with using a breast pump. She would recommend the use of a hospital grade electric pump, because this type
of pump more closely imitate a baby's natural sucking cycle of one suck per second. Breast pumps can be difficult to assemble correctly and the lactation consultant will need to teach the mother how to do this. She will also instruct the mother on how long and
how often to pump which varies depending on the situation. For example, a mother who has a baby in NICU would want to start pumping right away alternating five minutes on each breast for twenty minutes and she would try to do this every three hours (E. Orr, personal communication, March 8, 2005).
Many mothers would want to contact a lactation consultant if they have a low milk supply or if the baby is not adequately gaining weight. The lactation consultant would instruct the mother to feed her baby frequently, at least every 2-3 hours. It is more important that she breastfeed often, rather than having long feedings. The more the baby breastfeeds, the more breastmilk the mother’s body will be stimulated to produce. A lactation consultant would tell the mother not to go more than 5-6 hours between night feedings. It is okay to stop waking the infant for feedings once he is gaining weight well. It’s also important to instruct the mother not to smoke or drink alcohol because doing so can decrease the milk supply. A lactation consultant will give advice about the medications the mother is taking and always has a copy of the book called “Medications and Mothers’ Milk� by Thomas Hale. She would look up all the medications the mother was taking to make sure that they don’t affect the baby or the mother’s milk supply (Heinig, Jane, 2004).
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Now, having reviewed the main things that a lactation consultant is qualified to assist with, a few other problems mothers seek assistance for include: engorgement,
breast feeding twins, plugged milk ducts, mastitis (breast infection), thrush, weaning baby from the breast, retracted nipples, and nursing a baby with cleft palate.
The role of a nurse as a lactation consultant is actually quite extensive. “With a focus on preventive health care, IBCLCs encourage self-care, empowering parents to
make their own decisions, prenatally and postnatally. IBCLCs use a problem- solving approach to provide appropriate information, recommendations and referrals. They work in a variety of settings: hospitals (including maternity units), pediatric units, neonatal intensive care units and special care nurseries, lactation clinics, maternal and child health services, parenting centers, private practice as a lactation consultant and general medical practice, pediatric and obstetric practices� (International Board Of Lactation Consultant Examiners, 2005) The lactation consultants at Methodist Medical Center are available for telephone assistance as well. “The lactation consultant can provide referrals to community resources such as an breastfeeding support group, or local Women Infants and Children (WIC) agency� (Shinskie and Lauwers, 2002).
Lactation consultants are important to the community because they offer a vital role in breastfeeding success. “Experience has shown that IBCLCs contribute to improved breastfeeding practices and success rates and that they have the ideal qualifications to help their hospitals become baby friendly. By supporting and educating their colleagues, the overall standard of breastfeeding care is improved amongst all staff� (International Board of Lactation Consultant Examiners, 2005). Having a lactation
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consultant follow a mother’s stay in the hospital increases the duration of breastfeeding which then increases the duration of the benefits that the mother a baby receive while breastfeeding. “Infants should be exclusively breastfed for the first 4-6 months of life. Thereafter to meet their evolving nutritional requirements, infants should begin to receive nutritionally adequate and safe foods while breastfeeding continues for up to 2 years or beyond� (The World Health Organization, 2004).
Lactation consultants play a role in breastfeeding success by teaching the mothers what to look for. Breastfeeding mothers need to be aware of their baby’s feeding cues. The newborn will move his eyes rapidly behind closed lids, put his hands to his mouth, lick his lips and make sucking sounds, stretch and increase the movements of his upper body. Crying is the last cue that the baby will use to show that he is hungry. It is best to not to let the baby reach the point where he is crying out of hunger, because it is more difficult to get the baby to latch on properly when he is upset. Many mothers will become anxious because they wonder if their baby is getting enough milk. The lactation consultant will teach the mother to count her baby’s voids and stools in order to determine if he is receiving adequate nutrition. In the first 24 hours the baby should have at least 1 wet diaper and at least 2 meconium stools. Another sign the baby is getting enough milk is the transition of color in the baby’s stools. They will change from black tarry meconium to green and then to yellow seedy stool. After the first 3 days of life an exclusively breastfed baby should average 6-8 wet diapers and 2-5+ stools in 24 hours. Another sign that the baby is getting enough breastmilk is his weight. Before lactogenesis (the milk coming in) the baby can lose up to 7% of his body weight, more than that could
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indicate a problem. The mother’s milk should come in within 48-72 hours, although it can take 4-6 weeks to establish an adequate milk supply. After the mother’s milk comes in, the baby should be gaining 1ounce per day (E. Orr, Personal Communication, February 25, 2005).
Lactation consultants pass on their tips for breastfeeding success. Until the mother’s milk supply is well established and a good sucking pattern is consistently present, parents should avoid giving the breastfed baby a bottle or pacifier. Waiting at least 4 to 6 weeks is a good basic rule, because by then the milk supply will be established. The lactation consultant will tell the mother to support her body's efforts to make milk. She should avoid doing excessive housework, exercising vigorously, entertaining or working outside the home in the first few weeks. The mother should pace herself so she won't get too exhausted. Also, “If mothers and babies have unlimited access to each other, healthy newborns will request feedings approximately 8 to 12 times in 24 hours� (Shinskie & Lauwers, 2002). Frequent, prolonged feedings ensure that the mother's milk supply will increase to meet the needs of her infant.
As stated previously, one of the roles of a lactation consultant is supporting and educating their colleagues, which improves the overall standard of breastfeeding care amongst all staff. Educating other healthcare providers ensures that the breastfeeding mother will receive appropriate help when an IBCLC is not available. For instance at Methodist Medical Center the nurses on the maternity unit must complete at least 16 hours following the lactation consultant to learn how to assist breastfeeding mothers and attend a 4 hour breastfeeding class, taught by the lactation consultant. These classes are
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held for expectant parents in the community who wish to learn how to breastfeed their baby. They are usually held within the hospital every 2 months (E. Orr, personal communication, April 30, 2005). Family physicians and practioners along with nursing staff have the opportunity to emphasize breastfeeding education beginning with preconception visits and continuing throughout prenatal care, delivery, postpartum care, and during ongoing care (International Board of Lactation Consultant Examiners, 2005).This means that these healthcare providers should have good background knowledge of breastfeeding. There are breastfeeding seminars for continuing education hours which are hosted by IBCLCs. These seminars teach healthcare providers how to support and educate breastfeeding mothers.
Some may wonder how one goes about becoming an International Board Certified Lactation Consultant. There are several standard pathways. For pathway A one needs to have completed 4 or more years of college education. For pathway B one must have completed 2 or more years of college education. For pathway C one must have completed a bachelors, masters, or doctoral degree with a concentration in human lactation from an accredited institution. For pathway D one must have completed a Doctor of Medicine degree. All theses pathways require an additional 2500 hours of practice as a breastfeeding consultant, before sitting for the IBCLC examination (International Board of Lactation Consultant Examiners, 2005).
     There are several professional standards required and desired of a nurse applying to work as a Board Certified Lactation Consultant which include: “communication and counseling skills, history taking and assessment skills, documentation and
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communication skills with health professionals, skills for first two hours after birth, postpartum skills, problem-solving skills, skills for maternal breastfeeding challenges, skills for infant breastfeeding challenges, and management skills� (International Board of Lactation Consultant Examiners, 2005). The International Board of Lactation Consultant Examiners also has a code of ethics for the practicing IBCLCs which is: “The purpose of the International Board of Lactation Consultant Examiners is to assist in the protection of the health, safety, and welfare of the public by establishing and enforcing qualifications of certification and for issuing voluntary credentials to individuals who have attained those qualifications. The IBLCE has adopted this Code to apply to all individuals who
hold the credential of International Board Certified Lactation Consultant� (Internationl Board of Lactation Consultant Examiners, 2005)
There are many professional organizations and resources specific to lactation consulting and breastfeeding. They are very helpful in providing substantial information on theses topics. These resources include: La Leche League International (www.lalecheleague.com), The Academy of Breastfeeding Medicine (www.bfmed.org), International Board of Lactation Consultant Examiners (www.iblce.org), World Alliance for Breastfeeding Action (www.waba.org), The World Health Organization (www.who.org), and Medela (www.medela.com).
In conclusion, my findings show that it takes dedication and patience to be a successful lactation consultant. The IBCLC’s knowledge and expertise in the area of
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breastfeeding is a necessity for all maternity floors and the NICUs especially. Without lactation consultants we would not have as many healthy babies or happy mothers!
     





















References
Davies, J. (2002). A quick reference to medical terminology.
New York: Delmar Thompson Learning

Henning, J. (2004) Promotion and support of optimal feeding practices for infants
and young children. Journal of Human Lactation, 20, 137-139

International Board of Lactation Consultant Examiners. (2005). The role of an
international board certified lactation consultant. Retrieved March 10, 2005,
from http://www.iblce.org/role.htm

Lauwers, J., & Shinskie, D. (2002). Pocket guide for counseling the nursing mother.
Boston: Jones And Bartlett Publishers.

Walker, M. (2002). Core curriculum for lactation consultant practice.
Boston: Jones And Bartlett Publishers.

Wilson-Clay, B.,IBCLC. (2004). Nipple confusion. Retrieved April 16, 2005,
from http://www.medela.com/NewFiles/nipconfus.html

World Health Organization. (2004). Promoting proper feeding for infants and young
children. Retrieved April 2, 2005,
from http://www.who.int/nut/inf.htm