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Evolve Lactation with Christine Staricka IBCLC is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
As healthcare workers, we should not be creating drama in the first days of breastfeeding.
When you’re a parent in the throes of learning to breastfeed your new baby, it’s normal to have questions, doubts, concerns, and anxieties.
But if you’re a healthcare worker, you should have a solid understanding of the fundamentals of human lactation; you should be able to avoid adding to the confusion or struggle.
Join me on this episode of the Evolve Lactation Podcast where I discuss the vision, the mission, and the realities of early lactation support. (You can click Transcript above to read it if you prefer.)
Thank you for reading Evolve Lactation with Christine Staricka IBCLC. This post is public so feel free to share it.
Have you read my new book, Evolving the Modern Breastfeeding Experience: Holistic Lactation Care in the First 100 Hours? It is now available at this link.
You may also be interested in my Free Guide to the 3 Best Questions to Ask in the First 100 Hours. Grab your copy here!
I’d love to hear your feedback in the Comments after you’ve listened. Please share your experiences so we can keep the conversation going!
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I wrote a book about early lactation care, but not everyone is going to like it.
Many health care providers are going to have a hard time with this approach, even though it’s entirely evidence-based.
Join me on this episode of the Evolve Lactation Podcast where I read a chapter from my new book, Evolving the Modern Breastfeeding Experience: Holistic Lactation Care in the First 100 Hours.
The book is available now at this link.
You may also be interested in this free guide to the 3 Best Questions to Ask in the First 100 Hours. Grab yours here!
If you work with someone who has a really hard time advocating for breastfeeding, this might be the episode (and the book!) they need.
A clear understanding of breastfeeding and milk production is critical, but even that is not enough for people who have a bias against breastfeeding.
Healthcare providers have an obligation to advocate for protocols that are known to result in healthier outcomes, and breastfeeding is one of the most important health behaviors for both mothers and babies.
In this chapter of the book, I explain why so many people seem to resist advocating for breastfeeding, even some lactation care providers.
If you enjoyed this episode of The Evolve Lactation Podcast, please leave a review AND share it with a friend!
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Saknas det avsnitt?
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Hold on to your hats - this is a long, amazing, wide-ranging conversation!
I’ve been following the blooming IBCLC career of Nicole Longmire (@MotheringNurtured on IG) for several years now on social media.
Last week I reached out to her to praise her for a post she made that really resonated with me, and before I knew it, we were each in front of our podcasting microphones, pressing record.
In this conversation, we talk about so many things:
* mentorship of aspiring lactation consultants
* The First 100 Hours and my book
* our thoughts on the relevance of the WHO Code today
* ethics
* lactation career growth
* and so much more
Come along with me and Nicole for this important conversation!
Evolve Lactation with Christine Staricka IBCLC is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
If you’d like to learn more about (and from!) Nicole, check out these links:
Visit Nicole’s Website Here
Follow Nicole on Instagram
Subscribe to Nicole’s Podcast
The Milk Shakes Podcast Is Here
Mentioned in the Episode:
My New Book, due to release on April 2, 2024
Evolving the Modern Breastfeeding Experience: Holistic Lactation Care in the First 100 Hours
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Happy IBCLC Day! In celebration, I have a really special episode of the podcast for you.
I am so excited to share with you my conversation with my dear friend and fellow IBCLC, Adrienne Guirguis. I cannot begin to count up how much I have learned from Adrienne over the years.
She is everything you want your IBCLC to be: brilliant, compassionate, humble, confident, open-minded and accepting. She is a whiz at lactation triage on the hospital inpatient floor, patient and gentle with everyone who is in the room for a lactation consultation, and absolutely ravenous for new knowledge and information.
I would never hesitate to refer a client to her for any lactation issue, and I believe she represents the ideal in an IBCLC.
Let’s get to know Adrienne!
Adrienne Guirguis, a board certified lactation consultant, has over 25 years experience in helping breastfeeding infants and their families. She began her journey into the world of lactation after struggling to breastfeed her oldest son. She became an accredited La Leche League leader and was able to help babies breastfeed. Her experience with La Leche League led Adrienne to become a International Board Certified Lactation Consultant (IBCLC). She has been board certified for 20 years and has experience with a wide range of problems that may be experienced by new families. Adrienne has worked in hospital for over 10 years and then worked in community health for many years. She is a clinical practitioner, working hands on with families to improve feeding outcomes.Adrienne continues her lactation education, constantly attending conferences and courses to stay up-to-date on the information and skills needed to benefit those who most need breastfeeding help. She is a certified Specialist in Orofacial Myology.
In 2022 Adrienne completed the Holistic Integrative/Functional Lactation course, a year long program followed by a residency. This course has increased her skills to provide the best care for the families with whom she works.Adrienne also is an educator, working within the community to teach others the skills necessary to become lactation counselors and eventually board certified lactation consultants. She is the President of the Central Valley Lactation Association, an official chapter of USLCA.
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Adrienne joined me on the Evolve Lactation Podcast for a conversation where we take a look back over all of the settings in which she has practiced lactation care. The diversity of practice settings really sets her apart and gives her unique perspectives on how best to care for mothers and babies.
Over the span of more than 25 years, she has seen breastfeeding unfold over the hours, days, months, and years along the entire spectrum of infant and child development.
From teaching prenatal breastfeeding classes to private prenatal consultations, from seeing newborns nursing in the hospital to the community clinic to the home visit, and babies and toddlers of all ages in support groups, Adrienne has seen a lot in her lactation career.
One of her strengths is connecting with mothers and fathers, building relationships with them so that they can trust her with their lactation needs. Having a newborn brings the new parent into a vulnerable space, and Adrienne has a gift for engaging them in a way that brings them comfort and support so that they can enjoy their baby.
In fact, her connections with her clients are so strong and so important to the parents she serves that her private practice’s strongest referral source is word of mouth. People trust her with the lactation care of the people they love, and there is no greater testimonial than that.
In this episode, we take a ride in our time machine (because we’ve known each other and worked together for a LONG time!) and reflect on how lactation care has evolved over the years since we first met when she was my La Leche League Leader with my second and third daughters.
I love interviewing people on this podcast - even when I already know them, I learn a surprising amount about them by asking questions I’d never think to ask otherwise.
Come along with me and Adrienne for our conversation about our work, together and separate, as IBCLCs over the years!
If you’d like to learn more about (and from!) Adrienne, check out these links:
Visit Adrienne’s Website Here
Follow Adrienne on Instagram
See Adrienne’s recent presentation at the 2023 GOLD Tongue Tie Symposium
Mentioned in the Episode:
Learn more about Baby Café Bakersfield here
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My day-to-day work revolves around supporting the current and the aspiring lactation care provider with the resources they need to continue learning, to practice evidence-informed lactation care, and to treat people with kindness and compassion in their contacts with them for the purposes of lactation support. I am immersed in the world of lactation care and the universe of lactation supporters every single day. I am fully committed and I don’t intend to retire anytime soon.
That’s why I read that New York Times article with alarm. There are some very damaging tropes being perpetuated within it. (I refuse to link to it and give them even more website traffic. A quick Google search will bring it up.)
The New York Times has pulled out the American journalistic playbook on breastfeeding and lactation once again. They’re checking off the boxes on all the false narratives that confound all efforts to truly support people with their breastfeeding goals.
Those false narratives:
* everyone who is pregnant is pressured by everyone to breastfeed for the whole time their baby is a baby
* lactation consultants are overpaid people who exist to take your money and shame you into breastfeeding
* if you have problems with breastfeeding, you have to stop and do something else instead
* pediatricians are experts in breastfeeding
* the Affordable Care Act means that everyone has access to lactation care through their health insurance and insurance companies reimburse lactation consultants for their work
* hospitals push breastfeeding beyond the limits of safety
* clinical issues in lactation are easily explained or dismissed by people who have not studied them in depth or ever worked with a lactating dyad
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Here’s what I can’t wrap my head around: they could be using their platform to amplify information about how breastfeeding has been found to decrease the rate of Sudden Unexpected Infant Death, reduce first-year infant mortality, and reduce lifetime risk of breast and ovarian cancer in women and people who give birth, but instead The New York Times is publishing an article that calls lactation support into question and breaks the public trust in the IBCLC.
We don’t have time for this. Many, many people want to breastfeed and cannot access the clinical and peer lactation support they need to do so.
Publishing debate about a complex clinical scenario which impacts a small percentage of lactating dyads in a mainstream publication and then conducting what they called an “investigation” by people who are not experts in clinical lactation is not at all productive and it is, I would argue, harmful.
There is tremendous harm in perpetuating the myth that lactation consultants are greedy, unethical people whose only objectives are, according to the American journalistic playbook on breastfeeding to a)overcharge you for their services and b)make you feel bad for how you are feeding your baby.
Nothing could be further from the truth in either aspect.
I’ve spent the better part of the past 15 years specifically serving IBCLCs and advocating for the profession and the credential. I’ve volunteered with ILCA and USLCA, served on the Board of USLCA, served on local organizations and for non-profit AND for-profit companies which serve the IBCLC. I offer specialized services for IBCLCs and those aspiring to earn the credential.
I’ve been a practicing IBCLC since 2009, proudly serving families in California.
I could write an entire book about what I have learned from all of those experiences.
Thank you for reading Evolve Lactation with Christine Staricka IBCLC. This post is public so feel free to share it.
What I know is that people get into the field of lactation because they uncover that they have a passion and/or determination to break down the barriers to breastfeeding that they or others close to them have faced.
It’s a good thing they don’t get into it for the money because the math does not track. Most private practice lactation consultants do not make enough money to support their families and rely on their significant other’s income as well. This is because the market does not allow them to charge as much as they should for private consults. People won’t pay it.
(And please don’t come for me with the insurance reimbursement stuff. Sounds great the way it’s written into the Affordable Care Act, but in the real world, insurance companies have made it next to impossible for lactation consultants to be reimbursed, and even when they do, the rates are far below reasonable for the expertise and work that goes into a lactation consult.)
Also, let’s think about the breakdown of the field for a minute, too.
Most IBCLCs in the US are RNs, and most work in hospitals. They are paid an RN salary by their hospital of employment. Their salary is nearly always dictated by their RN license, not by the fact that they have earned the IBCLC credential. (This is why if you look up “average salary for a lactation consultant,” you’ll see a number which looks pretty unrealistic.)
For non-RN IBCLCs working in hospitals, which is another rarity, the rate of pay is generally lower than for an RN IBCLC. (Most hospitals use their RN IBCLCs in RN roles as well as lactation roles, so that means they have to be paid as RNs.) In my 10 years of hospital practice, my rate of pay was less than half that of an RN IBCLC.
It is also a fact that there are a number of IBCLCs in private practice around the country. In some states, there are many, while in other areas, there are incredibly few IBCLCs at all, let alone any in private practice. It is a specialized service of which the general public mostly has a loose awareness only during the timeframe in which they or their loved ones might need it.
That’s why these falsehoods about lactation consultants are so damaging.
We know that many people want to breastfeed because the data shows us that a vast majority of those who give birth breastfeed at least once in the hospital.
This is not because of, as the Times puts it, “intensifying pressure to nurse.” (Note that they linked this phrase to, inexplicably, the American Academy of Pediatrics’ guidance for pediatricians on Newborn and Infant Breastfeeding, a publication which does not in any meaningful way hold anyone accountable to pressure anyone to do anything, nor is it something the general public would routinely come into contact with.)
In fact, many mothers report that neither their OB nor their pediatrician actively encouraged them or educated them about breastfeeding; many report that they were told to switch to using a breast pump or formula if they had problems feeding at the breast. These are commonly offered solutions by people who do not know how to assist with breastfeeding, but they do not solve breastfeeding problems.
That can be problematic for people who intended to feed at the breast and now find themselves in a cycle of pumping and bottle feeding or using more formula than they intended.
Ok, so if there isn’t an intensifying pressure to breastfeed their babies, why do so many new parents put their babies on their chest and help them to latch right after they are born? It’s because they want to. They may decide after that to never do it again, or they may do it a few more times, or they may keep on going for days, weeks, months, or years. It’s always a personal choice to actually do it, no matter what people are told or what messages are put in front of them (excluding situations of coercive control by a partner who is forcing them to do so.)
The emotions around how babies are fed are always going to be intense because parenting a tiny, helpless human brings terrifying responsibility and the physiological reality of pregnancy, birth, and lactation brings waves of shifting hormones that re-shape how people think and act.
Lactation care providers use a variety of styles and communication methods to educate the public about lactation, and in one-to-one conversations and consultations with individuals, they work to build a relationship and trust so that they can provide answers, suggestions, and potential solutions to problems. Within that framework of relationship- and rapport-building, they do their best to communicate with empathy, clarity, and respect.
What if it’s not “pressure to nurse” that is creating this situation where people want to breastfeed but are unable to sustain it, but instead it’s a combination of:
* lack of widespread access to skilled lactation care by an IBCLC
* lack of referrals to clinical lactation care AND peer breastfeeding support
* over-reliance on pediatricians to provide information and assistance with lactation, something they are not routinely trained to do
* pressure to resume pre-baby activities and outside activities
* lack of support for new parents to care for their other children
* lack of widespread access to adequate paid family leave
* alienation and isolation or harassment of working parents who need to use a breast pump while at work
* constant, unceasing marketing of infant formula and other products which interfere with human lactation
I’ve taken criticism for my advocacy for the IBCLC; no process or certification is perfect, and there’s plenty of opportunity to get better. We’re still a young profession and we should collectively keep our minds and ears open for all of the ways we can improve it.
I also embrace that many, many people want to serve families through their pregnancy and lactation journeys without becoming an IBCLC; there are also many who simply cannot due to the resource constraints of the imperfect and evolving process.
The impact of the IBCLC credential is documented with strong evidence and has been for a long time. There is also ample evidence of the effectiveness and importance of lactation support provided by individuals who are trained as peers and/or lactation counselors and educators who have taken courses in the fundamentals of basic breastfeeding.
Yet this article’s very premise calls into question the expertise of one particular IBCLC and casts doubt upon the ability of an IBCLC to make a clinical observation or work with parents to create an appropriate lactation care plan.
They think they’re being slick by linking to documentation from our certifying board which details how an IBCLC can do their job when it comes to tongue tie in particular, but they present no evidence that the IBCLC they named operated outside of their scope of practice or violated their code of conduct.
Then they amplified the false narrative about how lactation consultants are so well-paid, printing the price an IBCLC charged for their professional health care services as a way to imply that this is a high-paying job.
The article attempts to explain a complex clinical lactation scenario - that of the infant with tongue function restrictions and its accompanying complications - in a publication for lay persons untrained in the nuance of human physiology.
Is tongue tie a relatively rare phenomenon? Sure.
Rare isn’t the same as non-existent. It’s not the problem for all babies who are struggling with breastfeeding, but it may be a problem for some. Calling into question the very people who are trained to assess and evaluate a dyad and provide education on how to mitigate problems is not helpful.
Tongue tie is a topic of ongoing study and research within the field of lactation and multiple other health care disciplines, and multiple forms of evidence with varying strength do exist to support explanations and interventions which might be useful when it is implicated.
Like many other clinical lactation phenomena which are understood well only by those who practice lactation care and study human lactation (such as the true incidence of insufficient milk production or the effects of medications on human lactation), tongue tie is too often simplified and dismissed by those who publish for clicks and website traffic.
Too long; didn’t read? Let’s not get confused or spend any more energy on this.
The worst harm done in this article is not to the issue of tongue-tie, though the article certainly does not helpfully shed any important light on it.
The impact of this article goes far deeper. Breaking down the public trust in lactation support and minimizing the impact that it can have on people who want to feed their babies on their bodies and with their own milk is unforgivable.
As lactation care professionals, we are not going to make any progress by spending our time debunking specific, clinical misinformation in public forums. (It doesn’t work; we’ve been banging our heads against the walls for decades trying to “bust the myths.”)
We are simply giving oxygen to the messages that should be extinguishing themselves.
Instead, let’s amplify truth and facts. Let’s use messaging that resonates. Let’s advocate for families to have access to high-quality lactation care and support in all of its forms. Let’s not worry as much about these click-bait pieces that distract from the true message that needs to be shared:
Breastfeeding is important, and help is available.
*I have learned so much about public health and science messaging over the past few years from many sources. Some that are incredibly insightful for me are:
The Huberman Lab Podcast with Dr. Andrew Huberman
America Dissected with Dr. Abdul el-Sayed
If you have a minute to share this article with a friend, I would be so grateful. It helps us have better conversations!
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In this talk, I discuss the challenges of talking about formula as a lactation care provider and provides ideas to stay inspired and ready to discuss formula with clients. I share my own experiences with infant feeding so that you know my context and emphasize the importance of understanding where clients are coming from when discussing formula. I also provide guidance on how to approach conversations about formula, including assessing the need for formula, exploring clients' concerns and preferences, and reminding them that formula can be a temporary tool if necessary. I highlight the role of lactation care providers in educating and supporting parents in making informed decisions about infant feeding.
It can be hard to talk about formula, but I’ve got ideas and guidance for you.
It’s our role as lactation care providers to help our clients and patients explore, learn, and make informed decisions when they’re thinking about using formula.
These frameworks that I discuss here on the podcast can help you approach those conversations in a neutral way and stay organized as you offer education and support.
This is a huge topic, so you can expect more to come on this.
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Why am I so serious about my work? How can we emphasize the importance of uncomplicating breastfeeding for individuals and on a population level?
In this new episode of the Evolve Lactation Podcast, I’ll discuss the need for over-education and continuous learning in the field of lactation care. I’ve got some encouragement for aspiring lactation care providers to seek out local connections, observe experienced practitioners, and engage in rich learning experiences.
I’m so excited to be back behind the mic, recording and producing my podcast!
What used to be called The Lactation Training Lab Podcast is now Evolve Lactation Podcast, and all the original episodes are there, too.
Remember, you can listen to all of it (from the beginning to the current episode) right here from this page, and you can also copy and paste this RSS link directly into your podcast player (like Apple Podcasts, Spotify, etc.) to get new episodes right there alongside everything else you listen to.
https://api.substack.com/feed/podcast/460460.rss
As always, please reach out and let me know how this episode made you feel, think, or act! You can send me a DM on Instagram @IBCLCinCA or email me here at [email protected].
Evolve Lactation with Christine Staricka IBCLC is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
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In this episode I discuss my holistic approach to building resilience in your lactation career, why it's important, and how Evolve Lactation can help.
We review 5 strategies for thriving in your lactation career:
- prioritizing your own physical and emotional health
- writing and re-assessing your practice philosophy
- uncovering your own biases
- being intentional in choosing your continuing education
- nurturing your connections and community
Evolve Lactation is where current and aspiring lactation care providers find the inspiration, resources, and connections they need to thrive in their lactation practice.
Additional resources are located at www.EvolveLactation.org
I am on Instagram as @IBCLCinCA
I offer 1:1 coaching calls to help you with your lactation career needs. Learn more here
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Welcome to my IBCLC© Day 2023 Series! Each day I’ll share with you one piece of insight about our work. (If you’re too excited and you just want to read them all now, go here and download the whole list)
Let me know in the comments if you agree, disagree, never thought about it this way, or whatever you’re feeling!
1. Even when you are an IBCLC, you won't know the answer to every question your client or patient asks.
Really - you won't. They will have questions you could never have imagined. This goes for questions you will be asked by nurses, doctors, neighbors/strangers who found out you "do" lactation, and more.
But here's the beauty: you will know how to find the answers they seek. There will be time to locate it. As you gain experience, you will begin to more easily navigate between those questions which actually have answers and those which do not ("there's really no research about this; that's why we base our practice on what we DO know and what makes sense biologically.")
You have your textbooks and study materials, you know about great websites for credible, evidence-informed lactation information, and you're building your network of lactation colleagues so you can seek guidance and expertise. You are helping, even when it takes a bit more time to locate the answers your client is seeking.
We don’t know everything we need to know right now, and science takes time because science is a process, not an endgame. Keep your mind open always to the wonder of human lactation and how it hits differently for every person. Keep asking questions.
Keep learning (and not just from formal continuing education opportunities - learn from those you serve, read your journals, spend time discussing cases and concepts with your peers, including those in other health disciplines).
Most of all, keep listening. We may hold expertise as IBCLCs, but there is always more we can learn.
2. The lactation plan you & your client or patient created might not be the one they decide to use.
Circumstances change. People change their minds. Regardless of how much time you and your patient spent creating the "perfect" plan for them and their goals, by the next time you see them or speak to them, they may have moved on to a different plan.
It's not a reflection of your worth as an IBCLC, nor is it an indication that your plan was not good. Your responsibility is to create the lactation management plan with your patient (and to document it).
The patient is in charge of using the plan, and they can use it any way they want - as a strict guide to exactly what to do, as a list of suggestions, or as a way to understand what it will take to meet their goals and then make a decision about what they really want.
When you learn that the plan is no longer in place, adjust your thinking, clarify what they need next, and be there for this next step. Show up for your client and their goals, even when they're shifting, and you can rest assured you are doing your job well.
You cannot have an agenda in this work. You are not here to make people fit into a plan that feels right to you. You have to learn how to identify your personal biases about childbirth, lactation, and health in general; then you need to learn how to allow your professional responsibility to your client to override your personal biases.
Supporting someone to meet their lactation and infant feeding goals is about building a relationship with them. It’s not easy for people to trust you, a stranger, when they are in the midst of experiencing the emotions and the whirlwind of life with their new baby. Remembering that can help you enter into each new dyad’s space with grace and respect. And keeping that perspective can help you navigate one of the more difficult - and sometimes surprising - realities of lactation care.
3. You won't "click" with every client.
It's just not going to feel comfortable with everyone. You may get off to a rocky start in conversation, you may feel unqualified to help them for some reason, or you may even actually be acquainted with them in some other arena of life, leading to some bit of awkwardness.
Build your relationships on respect and trust, and you'll find that people who may not seem to "like" you are actually quite glad to have your help. Show them that you are reliable and competent, and if there is a connection outside your lactation relationship, be very upfront with them about your commitment to confidentiality and protecting their private information.
You are going to connect easily with many of the people you serve, and when you encounter clients who leave you feeling a bit challenged, always be honest with yourself and take time to consider why it feels strained. Lean on your network of lactation colleagues to help you understand these moments, and you'll find that everyone has these kinds of different relationships.
What it looks like when you imagine a day in the life of a lactation consultant can be very different from the reality. You might envision feeling a real sense that you are making a difference every single day - changing lives, making people happy, squishing adorable babies. But the reality can feel very different. It’s important to know that going in so you can be prepared to remind yourself what you need to do to safeguard your own well-being in this career.
4. You may not feel like you accomplished very much at the end of a day of lactation work.
There's no inbox and outbox in lactation work. Even if you work somewhere that provides you a list of patients to see on your shift or you start the day with your schedule of client appointments, results are not obvious and easy to see in this job.
You may walk away from a day feeling as if you worked really hard and have no idea if you actually helped anyone. You may wonder if you are making a difference. Useful feedback can be hard to come by.
Focus on this: your role - and the commitment you made as an IBCLC - is to show up for people who are seeking or who require lactation support and clinical expertise, and to provide that to them in a competent and compassionate way. Did you do that?
You did. Even if you could never get that one baby to latch, and the mother you've been working with for 5 weeks is still struggling with milk production, and the parent on the phone is not seeming to accept the realities of the lactation plan you helped them create - you showed up for them and gave them the support they needed in that moment.
It can be really hard to see how much your presence, support, and clinical assistance mean to people. It can be even harder if you work in a setting where your co-workers do not value your knowledge or what you do, or where they question your impact because they misunderstand breastfeeding in general. It is in these moments that you must widen your gaze - look up and out to the larger lactation field and seek the professional support you need from your network of colleagues. You are part of something much bigger, and it helps to remember that every day.
5. It may take time for your clinical lactation input to be accepted by the rest of the health care team - even if they knew you before as an expert with a different credential.
It's true. Think of it this way: when you declared your intention to become an IBCLC, a slight separation emerged between you and the people you knew. You felt it. Some of them were incredibly supportive and respectful, while others put up a little wall (or a big wall). Why did this happen?
It's the passion thing. They don't have it, and they might have some resentment and conflicts built up around it. They're putting that on you. YOU represent breastfeeding and lactation now, and some people are going to have a problem with that (which can feel like they have a problem with you). It can feel like you are being accused of “going to the other side.”
Accepting this is something that is often unexpected when becoming an IBCLC. After all, we think lactation is fascinating and awesome, and it can be difficult to comprehend that others do not. It's ok - the world is made up of people who are fascinated with all kinds of different and amazing things. That's what makes life interesting!
However, when there's a lack of respect, that's when it starts to impact your work. If you're included in multi-disciplinary rounds in the NICU, but your input is consistently dismissed or ignored outright, it may be time to gently inquire of leadership as to how you can best fulfill your role there. If the pediatricians are not referring patients to you as the in-house lactation consultant, you may need to address how your role has been presented to them.
Essentially, these situations are usually opportunities to clarify your roles and responsibilities, and they are a great way to spread education about lactation. The most important point you can often make in these cases is a clear reminder that all health care workers have a responsibility to avoid their own personal biases about lactation when providing health care.
On the surface, it seems like a passionate interest in human lactation and a deep commitment to learning and serving others would be all you need to become a truly wonderful lactation care provider. However, we are (like everyone else) human beings with complicated internal lives, and there’s more to it than that.
6. Your personal lactation experiences can have a positive or negative impact on your practice.
Yes, you read that right. It's not just others in health care who can develop biases which impact their practice - we passionate supporters of lactation can have this problem, too!
Here’s why: though you may have learned tons of information, accumulated hundreds of hours of clinical experience, and passed a rigorous examination for board certification, you may not have had the opportunity to debrief your own personal lactation and birth experiences in a way which highlights your potential problem areas.
Biases can also form as a result of events that occur along the way in your lactation career - like when you miss something important, there’s a negative outcome in one of your cases, a client who complained about you, a wave of similar cases, etc.
These problem areas can be hard for you to see objectively, and they can absolutely influence the way you practice lactation care. It’s possible for your own fears and anxieties to influence your actions, recommendations, and ability to counsel others objectively. It’s not always obvious, and it can definitely leave you feeling like you are not effective in your role.
However, there IS a way to ensure that your personal lactation story can be used for good and woven into your actual mission and vision as a lactation care provider. Through a series of intentional exercises and coaching inside Mindful Lactation Counseling, you can do the work to open your mind and refine your ability to provide excellent lactation care.
Thank you for reading Evolve Lactation with Christine Staricka IBCLC. This post is public so feel free to share it.
One of the modules inside Evolve Lactation Community is a guided workshop called Mindful Lactation Counseling. It’s designed to help you uncover opportunities for personal growth in your lactation career, like revealing your biases and transforming your personal lactation story into a useful tool.
I’m obsessed with creating ways for you to build your resilience and strengthen your foundation so that you can impact more families through your personal touch as you provide them with lactation care.
Whatever we’re sharing, it helps us to feel less alone in this work. If you’re interested in learning more about how to join Evolve Lactation Community so that you can access the Mindful Lactation Counseling Workshop, drop a comment below with the word “mindful” and I’ll send you some details!
7. At the end of the day, your time and attention are what your clients and patients most appreciate and value. They want to feel heard.
It’s normal to feel some pressure around trying to “fix” the issues your patients and clients are experiencing. You may also feel pressure from those around you, others on the health care team, and even from your own mind as you try to make sure you are doing what you set out to do when you joined this field.
While the general population outside of Lactation Land may imagine that lactation consultants are most known for latching babies and helping people make more milk, we know the truth: new parents want to be heard. They want their own infant feeding goals to be recognized and elevated. They want their IBCLC to listen to them and to sit with them.
Sure, they want credible and practical information, clinical techniques to improve their latching and milk expression, guidance on how to navigate all that a breastfeeding journey brings with it - but most of all, they want to be part of something.
They want someone to listen to their birth story.
They want to know they're not alone in their pain or discomfort with a poor latch, their night waking, their frustration at washing pump parts AGAIN.
They want someone who understands and can remind them that things will get better and that what they are doing is important.
You can do this better than anyone because you have developed your counseling and communication skills and you have the evidence-based knowledge to back up what you are saying. You can support new parents because you - as one of the very few people on this planet with the IBCLC credential - understand how lactation fits into the context of not only infant and child development and nutrition, but also the biology and personal development and mental health spectrum of an adult navigating parenthood.
Your knowledge is critical, and your clinical skills are vital. What your clients respond to is how they are treated and how they are respected. Build the bridges your clients ask for by asking really great questions, listening to them tell their stories, and offering them all of the options you know, customized to their needs.
They will remember you. And you will know that you are impacting lives in a positive way.
Asking REALLY GREAT QUESTIONS is one of the hallmarks of an excellent IBCLC.
I’ve got a free checklist of 5 great questions to ask during a consult - you can download that here.
If you’d prefer to hear me talk through the questions and give some background as to what makes them really helpful, you can listen to this podcast episode here.
I’d also like to share this link to my totally free videos!
I truly hope you have appreciated this series and I look forward to hearing from you in the future! Happy IBCLC Day! - Christine
* Information about the IBCLC© credential and how to pursue it can be found at www.iblce.org
* Information about IBCLC Day can be found at www.ilca.org
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When we think about supporting exclusive breastfeeding in healthy term babies, we start from the default that exclusive breastfeeding works, that most people make all the milk that they need, that there are a set of practices that we do to make sure that happens, and there are the outcomes we look for to make sure that everything's going well. We observe and pay attention to ensure that, and we stand ready to assist if a problem arises.
However, for a certain subset of babies, that’s not a smart plan. If we lump the late preterm baby in with healthy, term babies and wait to see if problems show themselves, it puts these babies at more risk. They may not be getting enough milk. They may not be waking up enough to eat more. They may not be draining the breast well enough to protect milk production. We really can't take a wait and see attitude with these “early birds.” They need a separate set of practices to protect them and to protect the dyad’s capacity to continue lactation for as long as they choose.
Resetting how people think about late preterm babies has been a huge goal for me for many years now. It's about changing our own mindset so that we can support parents to approach this in the most prepared way: with the understanding that initiating lactation and breastfeeding with a late preterm baby is extra work.
It takes extra work at the outset, but that's not a forever thing. When people have that knowledge from the beginning, it can make it easier for them to manage early lactation so that it doesn't feel like this overwhelming burden.
Let’s talk about a mother I recently spoke with. She came to our service requesting help with making more milk. She was putting her baby on the breast frequently. She was pumping multiple times a day. She was bottle feeding her baby. She was using a pacifier and she was exhausted. What she was experiencing looked to her just like the same complicated lactation journey that many of the people that she knows have been on.
What I was able to share with her was that she was NOT experiencing the same scenario as her friends. With a new perspective, she was able to better understand the context of why her baby needed extra support to breastfeed and what to expect in terms of improvement and transition into uncomplicated breastfeeding and milk expression.
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Many people have found themselves in that same situation when they were unsupported on their lactation journey or lacked the prenatal education about breastfeeding that would have helped them have a smoother start. Many choose to stop or discontinue breastfeeding and/or pumping under all that stress. And the mother I’ve described would have thought that she was just like everybody else, and was faced with the same choices.
But she's not like them. And neither is her baby. Families of late preterm babies can think that what's happening to them is just like what happened to all their friends, but they actually have a different situation because their baby is different.
If we look at early lactation support for the late preterm dyad as a special opportunity to intervene, then we can help this population to see why how the extra tasks and work they do now really can set them up to meet their personal lactation goals despite the early birth.
It’s so easy for everyone to understand that a preterm baby will require extra care and even extra work for feeding, but the late preterm baby’s needs may be overlooked, to the detriment of their parents, who can be left thinking that their baby’s feeding difficulties are their fault.
Families and friends usually do not realize that these circumstances are truly not the same as what happens with healthy, term babies, and lactating parents can end up being discouraged from breastfeeding or expressing milk under the guise of protecting them from the extra work.
In another case, as I worked with the mother of a late preterm baby and helped her create a lactation care plan to protect her milk production, keep her baby fed, and practice breastfeeding despite her baby’s seeming lack of ability to stay awake for full feedings, she went to her midwife for post-birth care.
Unfortunately, her midwife was not well-versed in the lactation needs of the late preterm baby, and she discouraged the mother from following our carefully constructed lactation care plan, telling her instead to “just keep putting the baby to breast, you don’t need to do all that extra stuff.” That’s risky for a late preterm baby, and it risks compromising milk production as well.
All of us who work with pregnancy, birth, and lactation need to be on the same page about lactation care of the late preterm dyad. It’s different, and it’s critical that we facilitate a wider understanding of this to offer these babies and their parents the ability to experience lactation.
Without this crucial shift in thinking, we are failing these dyads. Together, we can ensure that late preterm dyads get the right lactation care at the right time. I’ve got plenty more to come on this topic - stick around!
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If you are getting into the field of lactation care, you need to be ready for the trickery. Be prepared.
The marketing deception, the lies, the outright bribery - it’s all coming at you. They’re just waiting to capture your attention and divert you from the science.
Marketing works; that’s why companies spend money on it. It works on everyone. Works on me, that’s for sure. It’s why I drink a certain kind of sparkling water and wear a certain kind of tank top. Maybe for you, it’s about the car you drive or the shoes you wear. Maybe it’s the phone you’re reading this on - you’ve got brand loyalty somewhere.
With lactation, it’s not ONLY about brand loyalty. It’s about the product mentality itself. Companies know the “motherhood market” is ripe for profit, so the goal is to ensure that everyone thinks people need tons of stuff when they have a baby. Free baby registry? Sure. Free samples of baby products? Yep. Free prenatal vitamins and supplements? You got it.
And… they’ve got you. If you’re an aspiring lactation care provider, they’re working really hard to capture you, too. You’ve got to know that. You’ve got to see it.
Remember when I said that marketing works on me? Well, there’s an exception. There’s a little switch you can turn on and off. It comes from education and evidence-based information and a commitment to truly helping and serving people.
I know and accept the science of human lactation as demonstrated through the evidence base and the concept of physiological plausibility. I can see when a product is being marketed that has a potential influence on human lactation, and I can run it through that filter. Is it really needed? Why? What happens if someone can’t get it - are they destined to fail at breastfeeding? The company sure wants everyone to think so, but is that really possible?
Here’s where they try to capture you: you probably already know how companies prey on the lack of information new parents may have, giving them tidbits of truth couched in confusing, out—of-context ideas. They’re ALSO hoping this will work on you as a lactation care provider. They want to take advantage of any doubt you might have about your education or knowledge in the science of human lactation.
They’re counting on their slick marketing campaigns, catchy slogans, and your tiny bit of wondering if you really understand everything about how lactation works to convince you that maybe their product is kinda necessary for everyone. They’re definitely hoping that if they can get you to take a sample and try it (or give it to one of your clients to try), or if they can join you for a Live on Instagram or get you to talk about their product in a social media post or video, that they will benefit from your reputation and your clients will believe in their product and buy it.
The key to resisting marketing when it comes to products which make claims about babies is this: adopt a mindset of scarcity.
Is it possible that this product is actually necessary? Well, yes, but for one person at a time, not for everyone. How would they know if it is necessary for them? By having their situation evaluated by a professional, someone in whose scope of practice it lies to recommend the use of a product.
If it is not in your scope of practice to evaluate and assess an individual or a dyad AND to understand AND be able to explain the potential positive and negative effects of a product, technique, or service, you should not be talking about products. Period. Refer to another model of care.
No breastfeeding product is right for everyone and not everyone needs breastfeeding products. That’s why it’s imperative that we collectively get a handle on this now. There is NO REASON that anyone should be out there endorsing products that can impact lactation (in positive or negative ways!)
If you are approached to receive a free sample, do not accept it. If you are professionally curious, purchase the product. Do NOT test products on your clients. Do not share YOUR own results with a lactation product as if they are irrefutable evidence- you are one person. Your experience is valuable and possible instructive to others, but that would require you to evaluate and assess the person you are telling and to determine if it might be the right fit for them. You are NOT RESPONSIBLE for marketing any products, even if they worked great for you, and it’s simply unethical for you to do so.
You are responsible to make sure that the people you serve are aware that fundamentally, the use of products and tools* is not necessary for most people SO THAT if they choose to use things, they are actually making an informed decision. You are responsible to resist marketing claims. You are responsible to know and to educate others that no brand of product has a scientific, peer-reviewed evidence base to be able to claim that it helps with any part of the process of human lactation. It doesn’t exist. Research funded by the manufacturer of a product is not objective and does not carry the same weight as other types of evidence.
You can help many more people by educating them about the reality that breastfeeding products are not necessary for most people, and that getting good help is the best way to resolve problems or doubts they may have.
If you’re going to have the privilege to assist people with working to meet their own infant feeding goals, be a process specialist, not a product specialist.
Excel first in the art and science of supporting human lactation and complementary feeding. Then, if you develop an interest in and an ability to study it more, add specialization in a type of product and its uses. Brands come and go, but knowing exactly how and why a type of breastfeeding product may work or may not work, based on our knowledge of human lactation, is the truly valuable part.
Thank you for reading Evolve Lactation with Christine Staricka IBCLC. This post is public so feel free to share it.
*Products and tools marketed for use before and during lactation include, but are not limited to: vitamins and supplements, breast pumps, nipple shields, nipple everters, herbal preparations, teas, cookies and snacks, protein drinks, supplemental feeding systems, bottles, bottle nipples, pacifiers, and more.
This does NOT mean that these products are not ever indicated for use or that they should not be recommended or that parents should never choose to use them. It DOES mean that informed consent for their use is critical because they inherently can impact human lactation and breastfeeding.
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Something is missing in modern parenthood. Parents find a lot of messaging in their lives but not a lot of actual information about how to implement things.
Social media is an easy structure on which to place blame, but truly all media holds some responsibility. Cherry-picked research articles framed in ways to grab attention, advertising space offered to anyone who can pay, mis- and dis-information peddlers protected by free speech - these all play a role in how parents are constantly shown bits and pieces of facts and myths, broken up and dissociated from a larger framework that would give any of them context.
Commercial influencers and companies say whatever they need to say to earn money. It might be based on fact but missing large pieces of relevant perspective. It could be based on myths that persist despite being scientifically refuted, or simply presented in a confusing way. (Here I am thinking specifically of infant formula manufacturers telling parents that breastfeeding causes mental health issues and formula does not - one of those things that could seem simple if you aren’t given all of the information.)
A long time ago I wrote on a piece of paper that “nothing means anything by itself.” I go back to that thought all the time. Perspective and context are absolutely everything. Nothing is simple. Even if you have the type of personality which sees the world as black or white, A or B, good or bad, you are still taking things into account when you do that.
I spend a lot of time thinking about what would make things better for parents who want to breastfeed* their babies. How could we simplify things so that they had the information they needed before they even need it?
The problem is that we can’t simplify it. It’s complex. It’s nuanced and personal and related to so many things that it isn’t possible to distill everything down to the simplest messages that will resonate for everyone.
Tell me a universal “truth” about lactation and I’ll show you an example of an exception. We try and try to create messages that are positive and informative and useful for all, and in the end there’s always at least one negative response OR a person who tells you that it didn’t work that way for them.
One of the concepts I teach my students and interns is exactly this: there’s no one way to solve any lactation problem your client brings you. If you think there is, you are not providing client-centered care.
A messaging ecosystem I built recently revolves around these 2 tenets: breastfeeding is important, and breastfeeding help is available.
I stand behind these statements because I believe they are helpful to many, but I know for a fact that there are exceptions. Breastfeeding IS important, but there are cases where it is less important or holds more risk than not breastfeeding. Help IS available to many folks, but unfortunately, it is not always accessible, affordable, of high quality, culturally-matched, etc.
In the end, though, these 2 statements make for a solid foundation on which I can make many points of conversation. They allow me to expand in ways that I need to expand in specific settings.
It is never simple to talk about breastfeeding. The longer I am involved in activities which require me to do so, the more I feel that in my bones. One of the most popular social media posts I have ever made is here:
It’s 100% true. No matter who is involved in a conversation about lactation, they are involved on a personal level. Think you’re talking to someone who has no horse in that race? Chances are, someone they love has one. When you talk about breastfeeding, people find meaning far beyond your intentions.
We have a responsibility to be sensitive to that, but more importantly, those of us who have been privileged to become educated about it have a responsibility to share our knowledge in ways that can improve things for others.
Ultimately, that means that people will be sharing their knowledge in a wide variety of ways, and sometimes those ways won’t resonate with us personally. We just have to remember that they will resonate with others. This is never more obvious than during events like National Breastfeeding Month and World Breastfeeding Week.
We will all do well - including me - to show grace and continue to elevate all voices which endeavour to share wisdom and knowledge about breastfeeding in nuanced and complex ways, even if their tone or wording feels uncomfortable to us.
I also think that the responsibility to share our knowledge also shows up in the ways we choose to serve families. If it has been on your heart and mind to teach prenatal breastfeeding education, I’m feeling that lately, too.
Because I have recently been working with lactation folks who want to rediscover or redefine their purpose in this work, the topic of prenatal education keeps surfacing.
When you know your specific reasons, objectives, and the people you most want to serve as a lactation care provider, developing a prenatal breastfeeding course is a natural fit.
While hospitals and obstetric practices may offer their patients online education about breastfeeding, it is inherently generic and basic.
Breastfeeding isn’t generic or basic, and as previously established, it’s not simple. Why should a prenatal breastfeeding course be basic?
You could use your specific talents, knowledge, background, cultural reality, language, past career perspective, or whatever is really unique about YOU to develop a prenatal breastfeeding course that targets your intended audience.
We don’t have to just pick what kind of course to teach from topics like “getting started” or “how to combine breastfeeding with work.” With the technology available to us, we can create really special courses and find exactly the right people to teach. And we don’t have to limit ourselves to teaching only pregnant folks, either - we can develop supportive courses that are available on-demand to new parents with babies and toddlers that educate them on the current realities of their feeding journeys.
Of course, educating folks about breastfeeding helps them understand the importance of getting help if they need it, it brings them into peer support groups, and it builds up those relationships we most need in our lactation practices. It helps parents feel good about how they are being proactive and getting prepared. It helps them get answers to questions that cause them to doubt themselves or their choices. It helps, period.
The theme of National Breastfeeding Month this year is “This Is Our Why.” What is your why, and how could you develop a way of teaching and supporting breastfeeding families that honors your why?
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The proliferation of tools and devices designed to be used during lactation has occurred without an accompanying body of research to support it. Parents are receiving hundreds to thousands of marketing messages for these products during pregnancy and lactation, a time when they are especially vulnerable to being influenced about making buying decisions that they are told can impact their ability to breastfeed. In fact, any tool or device designed to support lactation can have a negative impact if used improperly or without indication.
Much like the "cascade of interventions" terminology used to describe how labor interventions accumulate, parents can also experience a cascade of lactation interventions. Lactation support providers in every setting need to keep up with the use and indications for these products and understand how to recognize when their use is becoming problematic so that they can educate parents prenatally and provide appropriate lactation care and referrals to a higher level of clinical lactation care or medical care as needed.
Evolve Lactation with Christine Staricka IBCLC is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
In this session, we’ll talk about how we can help simplify lactation for so many by ensuring the basics are always in place.
Thank you for listening! I appreciate your support.
Here’s a link to a handout that goes with this session.
When you share my posts, it helps this information reach more people, and that’s my goal:)
References for this session
Alibhai, K. M., Murphy, M. S., Dunn, S., Keely, E., O’Meara, P., Anderson, J., & El-Chaâr, D. (2022). Evaluation of a breastmilk hand expression toolkit: the MILK survey study. International Breastfeeding Journal, 17(1), 8.
Çınar, N., Karakaya Suzan, Ö., Kaya, Ö., Karataş, H., & Duken, M. E. (2021). Investigation of the Effect of Human Milk Expression Techniques on Milk Content: A Systematic Review. Journal of Tropical Pediatrics, 67(6), fmab108.
Johnson, H. M., Eglash, A., Mitchell, K. B., Leeper, K., Smillie, C. M., Moore-Ostby, L., ... & Academy of Breastfeeding Medicine. (2020). ABM Clinical Protocol# 32: management of hyperlactation. Breastfeeding Medicine, 15(3), 129-134.
McCue, K. F., & Stulberger, M. L. (2019). Maternal satisfaction with parallel pumping technique. Clinical Lactation, 10(2), 68-73.
McGuire, M. K., Seppo, A., Goga, A., Buonsenso, D., Collado, M. C., Donovan, S. M., ... & Van de Perre, P. (2021). Best practices for human milk collection for COVID-19 research. Breastfeeding Medicine, 16(1), 29-38.
Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Widmer, K., ... & Academy of Breastfeeding Medicine. (2022). Academy of Breastfeeding Medicine Clinical Protocol# 36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360-376.
Moorhead, A. M., Amir, L. H., Forster, D. A., & Crawford, S. B. (2022). ‘Is there any point in me doing this?’Views and experiences of women in the Diabetes and Antenatal Milk Expressing (DAME) trial. Maternal & Child Nutrition, 18(2), e13307.
Shehata Ibrahim, S., El-Shabory, M. E. S., El-Hoda, N., Abdel–Fatah Mohamed Shehata, A., Mansour Moustafa Mohamed, S., & Osman, A. R. (2023). Effect of Hand Expression and Lactation Support on Self-Efficacy of Primiparous Mothers and Quality of Breast-feeding. Egyptian Journal of Health Care, 14(1), 34-44.
Witt, A. M., Bolman, M., & Kredit, S. (2016). Mothers value and utilize early outpatient education on breast massage and hand expression in their self-management of engorgement. Breastfeeding Medicine, 11(9), 433-439.
Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation, 32(1), 123-131.
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It was with our second cohort of teaching future lactation educators that my colleague and I realized that some of our students needed more than just knowledge and information. They were in tears as they absorbed the information about how human lactation works and best practices. Some were angry, too, that they were given bad information when they were trying to breastfeed. They followed us into the restroom to talk about their personal journeys, they sat with us at lunch and let their stories unfold, and they bonded together over what they had experienced.
These folks, themselves, needed post-lactation counseling. They needed help understanding what had happened, a chance to think it all through without the fog of being a new parent, an IBCLC to help them re-frame their story into something they could use as a teaching tool and a springboard for motivation.
Aspiring lactation consultants are not required to undergo any type of formal or informal debriefing process about their own lactation and birth experiences. Considering that these are some of the most transformative experiences of one’s life, this is surprising and disheartening.
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Years ago, when I first learned from a licensed medical social worker about the debriefing process she underwent in her professional training, I immediately wondered why this was not a standard part of the process of becoming a clinical lactation care provider.
Some of us had the opportunity during our mentorship to participate in conversations and/or deliberate opportunities to discuss and process our lactation and birth journeys. However, without a requirement to make sure this happens somewhere along the way, new IBCLCs are minted every year who could be unknowingly bringing their distress, trauma, and grief over their own personal experiences into their work helping others.
What’s important to understand about that is this: not only can that potentially impact the lactation care being provided to clients, it can also potentially make the work of lactation care more difficult and for some lactation care providers, unsustainable in the long-term.
I am really focused on making the work of lactation care fulfilling and sustainable. I want to see the brilliant people who are working so hard in this field have a clearly defined personal mission, all the tools they need to do the work, and the resilience they will rely on over the years. I do not want to see us losing people because they burn out early, feel undervalued, and get frustrated at their perceived lack of impact.
That’s why I care about folks having the opportunity to do some self-reflection about their own experiences and how they are impacting their work.
At its core, this is about offering lactation and birth workers a guided plan for examining their own birth and lactation journeys, the stories they have told themselves and others, and the ideals that guide their work. With that self-reflection, they can then begin to see if there are places where their own experiences are leaking through in the care they give.
Consider this: of all the angry, tearful, and frankly sad stories we see new parents sharing on social media when we bring up childbirth and breastfeeding, some of those folks are going to be inspired enough, mad enough, courageous enough to enter into this arena of care. But there’s no built-in place where they will get to process their own baggage as they get educated.
They may learn the facts and the science of human birth and lactation, but they won’t by default be given the chance to unpack their own experiences. Unfortunately, that is likely to impact their counseling abilities as well as their own job satisfaction.
For now, let’s start with this: I shared above that I really want to help you grow and thrive in your lactation career by building resilience.
Click here to download a mini-workbook where you will revisit your motivations and mission for doing this work.
I’d love to see your completed worksheets and start a conversation about your mission! You can DM me on Instagram @IBCLCinCA or email me at [email protected].
Evolve Lactation with Christine Staricka IBCLC is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
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There isn’t anything you can say about breastfeeding in our culture that won’t be met with vitriol and accusations. It can be true, it can be your personal experience, it can be the literal results of a well-done scientific study that was not funded by industry or anyone with a financial or reputational stake in the outcome.
If you say “breastfeeding,” it will be met with polite argument at best, insult and accusation at worst.
We know this is where we are, and we work really hard to create messaging that will help spread accurate information about breastfeeding and human milk in a way that educates and influences those in a position to make a personal choice about feeding their infants or to influence others’ choices. It’s complex, but we do the work because we know it matters.
Occasionally, though, we experience these moments of Many Eyes Upon Us because of some large or significant or splashy study about breastfeeding that the mainstream media picks up and amplifies. (Also happens predictably each August during World Breastfeeding Week.)
Now, admittedly, I am biased toward research which gives me something tangible that I can use to impact my lactation clients right now, something I can tell my client with the non-latching baby or the difficulty finding the right routine to make exclusive pumping work in their situation. I want practical stuff, clinical things. I want to help people feel successful with their lactation journeys right now.
Research about long-term outcomes is useful, but it’s not helpful to me on a day-to-day basis. I need to know it, and I value it for its part in the larger picture of why breastfeeding is important. (I say that with full confidence that it will anger someone who will say that I am biased because I say that breastfeeding is important. But we cannot refute that breastfeeding is the physiological norm for the mammal, which we are. I am biased toward things which are important to upholding the physiological norm, like being able to breathe without impediment, not being infected by pathogens, consuming high-quality nutrients that fuel the body, moving one’s limbs without pain, etc - you see, all things all I am biased toward which serve to preserve health and survival over the lifespan, and breastfeeding is one of those things.)
The study currently being screamed aloud talks about long-term cognitive outcomes of breastfeeding. Cool. But can I please get a study on pump flange size and impact on milk output? How about some on the “new mastitis protocol?” What about the best wound care regimen for babies who have had a tongue tie revision?
If you are a person who loves breastfeeding and human milk and want to see it shouted from the rooftops, then this study about cognitive outcomes is pretty easy to get behind. But it doesn’t really help us today.
It doesn’t actually give us something new to say or do in the hospital room of an exhausted, overwhelmed new mother who is trying to decide how important breastfeeding truly is to her as she’s struggling. It does not help me offer better technique to the lactating parent of a 4-month old whose milk production is falling off when they are still pumping the same amount of times per day. I can’t use this information about cognition outcomes on a regular basis. You can’t say to someone who is in tears over their lactation situation that “breastfeeding makes babies smarter!”
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That’s why I don’t engage in social media battles about things like this. You won’t see me debating online about a study. Most of the people who are online yelling at you about this do not understand any of the context this comes with.
Sure, many responses to this piece will accurately reframe the issue around how we need evidence like this to support why it is that we need to spend loads and loads more resources on providing adequate lactation support to people and improving paid leave policies. All true, all necessary, and an absolutely key part of the larger issue and the context people really need to have in order to understand what this study means.
But there’s even more. It’s not JUST that. There’s the commercial influence on infant feeding part of it, there’s the fact that (not to beat a dead horse, but…) we actually need plenty more scientific research on the nuts and bolts of human lactation in order to improve people’s experiences, there’s the commercial influence on the experience of lactation (with all the tools and devices and things that are being marketed to parents), there’s the greater issues of access to health care and health insurance and poverty and health literacy and lack of family support and, well, you get it.
The context is not only that we need to provide better lactation support so that people can actually do the thing that helps support brain development. It’s multi-layered and complex, and it reflects so many other things we debate in the US and elsewhere. Like I said, it’s cool to think that (as this study says), breastfeeding might lead to better cognitive outcomes later on in childhood/adolescence.
It just isn’t the most salient thing that a pregnant woman or a new parent needs to hear. It’s a public health teaching tool, but it’s not an individual counseling tool.
We’ve got to separate those things and treat them each differently. Splashing a headline about breastfeeding babies being smarter does not actually achieve any of our goals, and it further alienates people we really want to help grow in their understanding. Let’s be thoughtful and intentional about this, and let it be a call for all that clinical research we need.
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I finally figured it out.
Over the past five years, I’ve been creating so many presentations and tracking so many ideas. I want to make these presentations accessible to more people, and I also want to keep creating new ways to share what I know and what I have learned. Learning from podcasts - from just listening to experts talk through things - has become such a huge part of my life, and I feel like it would be such a great way for others to learn and keep building their lactation knowledge.
I have also been writing here on Substack for a while, and I love it! There is so much about this format that makes it a logical choice for someone with ideas and knowledge to share them.
Which brings me right to the point…I’ve got notebooks filled with ideas of things I want to write for you AND talk through for you in audio format. I have created more than 20 separate CERP-level presentations over the past 6 years or so. Many of them have associated handouts and guides to supplement the learning process. I have published 24 “official” episodes of The Lactation Training Lab Podcast (which will now be transitioning to the Evolve Lactation Podcast and be available right here for you.)
It’s time to bring them all together and make it easier for YOU!
Using Substack as my platform, I can write for you AND record for you. You’ll have ONE place to find everything, and it will be organized. You can share ONE link with your colleagues when you want them to hear something you learned or that resonated with you.
You can read things, and you can listen as well. You’ll get updated when there’s something new, and we can chat about it in the comments so that YOUR voice can be heard as well.
I’m adding a Paid Subscription level ($8/month or $75/year) to ensure I can provide you with all of the rich background you need, like references from journals, links to related resources, and all of those downloadable handouts I mentioned above. This is my livelihood and my expertise, accumulated over more than 23 years in the lactation field, and I am confident it is worth the subscription price I am offering.
I envision you listening while you walk or work out or do stuff around the house. I can see new IBCLCs listening in between consults or on their way to the hospital or clinic for their shifts. I can imagine IBCLC exam candidates listening in over the months/years they are studying for the exam.
I want to be a consistent mentor to those who are in the process of becoming a lactation care provider. Clinical mentorships can be fleeting, but I’m going to be here, writing and podcasting as I continue to learn and gain insight as a lactation consultant. Social media is fun and exciting, but it disappears, and I don’t want to spend all my time creating things that hardly anyone sees.
I’ll still be hosting the amazing Evolve Lactation Community membership because, well, it works. Members love it, I love it, and it’s a valuable learning opportunity. The most loved part of it is the coaching calls, and now members have the option of scheduling private coaching calls with me in addition to attending the bi-weekly group calls. (If you’re not a member and you are interested in a coaching call, check out this link here.)
In A Nutshell:
This Substack newsletter is going to get better and have more content, PLUS I am adding a podcast to it. It will be simple. Stick around.
Love ya, Christine
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I attended an in-person conference and came away with some big realizations about the state of our work and advocacy. There have been some big shifts in this field which have led us to a place where new parents are becoming more likely to be encouraged to feed human milk than they are to breastfeed, regardless of what their own plans are and outside of the realm of informed decision-making. There are some huge gaps in understanding and some really influential marketing problems creating a growing voice that is, in my opinion, shifting sentiment away from breastfeeding.
Formula, infant feeding product, and breastfeeding support product manufacturers and companies continue to spread divisive and confusing messages that cause stress for new mothers and fathers, while well-meaning folks engaged in providing health care - and lactation care - are starting to equivocate on how important breastfeeding itself really is.
In a room filled with people whose job it is to support breastfeeding, I heard an overwhelming message that “everyone pumps now anyway so we can’t be talking about breastfeeding - it makes people feel bad.”
Wow, sounds familiar. That’s what everyone said/still says when we talk about breastfeeding and formula feeding and guilt. So here we go again with a whole new line of marketing - yes, marketing - that we need to spend time navigating.
We need to be clear: companies that make formula, pumps, bottles, and breastfeeding tools/devices are working as hard as they can to trick us, manipulate us, and change our behaviors to benefit them. All of us. They need us as lactation care providers and other health care providers to market for them and endorse the use of their products, and they need parents to buy their products. It is an entire system, it is extremely well-funded, and we can’t be lulled into thinking that they are “only trying to help.” They are not. They are trying to get people to buy things. They are trying to get us to market for them by being advocates for the use of their products.
“Things” are not always bad, but neither are they always needed, and using them when it’s not indicated can lead to lactation problems.
If the loudest message we are all hearing is that breastfeeding is too hard for most people and many folks don't make all the milk their babies need, what choices will that lead to (for new parents and for lactation care providers)?
If the general sentiment is that most people are “too stressed” by breastfeeding and infant sleep and that it's “always” or “usually” problematic for parents' mental health, what lessons and messages will we collectively start sending in our effort to support people better and prevent mental health crashes?
If lactation care providers are constantly posting on social media about lactation complications and negative messaging because those posts are click-bait and they earn them paying clients, how are they meeting their obligation to protect, promote, and support breastfeeding? How are they educating the public?
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I'm starting to see some similarities here to the conversation many have in the birth field about how most medical obstetrical providers have “never” or seldom seen a non-interventional labor and birth. As more and more (and more!) of our lactation clients are using pumps and bottles while leaning away from breastfeeding and we become more educated and skilled in how to support them, are we losing touch a little bit with what it's like for people who are breastfeeding without using any “stuff?” They have critical and time-sensitive lactation support needs, too.
I've really been leaning into my own deepest interest in lactation care: early lactation support and the fundamentals of human lactation. I have wondered if that's just my brain saying “I can't possibly catch up with all the new stuff," but I don't think so. Rather, I have realized that it is going to be critical to continue to strengthen the knowledge and advocacy capacity of the legions of lactation educators and counselors out there.
There are far more folks engaged in everyday lactation support who are tasked with non-clinical tasks and the application of what we think of as “fundamental lactation skills” than there are clinical lactation care providers (IBCLCs). By its very nature, it is critical that this non-clinical workforce remains steadfast in ensuring that every parent in their sphere of influence is given the building blocks they need to make healthy choices in feeding their babies and is protected from the harmful messages that create doubt and fear.
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This means we have to keep talking about the WHO Code, about ethical lactation care, about the scientific evidence base for what we teach and do. We have to keep participating in local and regional coalitions and task force efforts to educate our communities and our peers. We must continue to model the best counseling skills we have to create an environment where new and expecting parents can repeatedly encounter positive, practical, and truthful messages about how to prepare for and how to navigate lactation.
I’m not saying that lactation care personnel should be going into every interaction with an agenda of persuading people to breastfeed and avoid using products. What I am saying is that lactation care personnel are literally the last line of defense that parents and families have when they are facing strong and persuasive marketing messages by companies wanting their money.
We need to make sure that as professionals, advocates, and compassionate humans, we are avoiding even the appearance of being influenced by product marketing. We need to actively work to educate families using the evidence on infant feeding practices and outcomes, and we need to be at the absolute top of our counseling game so that families are able to connect with and trust us.
It’s a nuanced and careful game. It’s hard to say some of the things we have to say to parents. We’ve always had to tell parents things they did not want to hear. It’s important that we continue to be honest about what we know and don’t know even while we are providing the most supportive care and encouragement that we can.
I’d love to hear from you: what’s the toughest truth you have to tell your lactation clients?
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Just a taste of the wisdom Amy Porterfield, online course creation and marketing expert, shared with me in our conversation recently:
“I can promise you that you are really good in one specific area, if not more, in your industry. There's more money to be made - and a bigger impact you can make - when you figure out your thing, what it is that you are really good at in your area of expertise.”
On marketing: “Don't expect yourself to know this! Find a guide who's gone before you and learn from them. Don't let it start you thinking ‘I would never know what to do.’ You can figure it out, I promise you.”
On investing the time to create a digital course: “it's an asset that you're creating one time, but you're going to benefit in terms of revenue over and over and over again.”
On what it takes to integrate building an online course into your life even when you have a day job: “What it looks like is you dedicating a few hours a week, whether it be three hours, five hours, eight hours, if you have it, (most people don't have that much time), but you have to book it into your calendar and say, I want something more in my life…. So it's just a matter of discipline, like anything else, but understanding why you're doing it will help you show up for those times. You said you would.”
On her appreciation for lactation consultants: “I love the work that you do and all those that are listening, what they do. I remember when my sister worked with a consultant and how much it changed her life, and so I have a sweet spot for all of you listening. Thank you so very, very much.”
When you are done listening to this podcast, you are going to want to hear more from Amy! Here are a couple of ways you can do that:
Listen to Amy's private, limited-time podcast series here Find Your Thing - your special area of expertise - using Amy's FREE guided exercises here Learn more about online course creation and get a headstart on yours in Amy's new Course Confident Bootcamp here
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On this episode of The Lactation Training Lab Podcast, my friend and colleague Fiona Lang-Sharpe turns the tables to interview me on my own podast. Together we break down the 3 elements of a great lactation consult. You'll get to know us both a little better as you listen in on our conversation!
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Join me for a conversation with Irish IBCLC and antenatal educator Niamh Cassidy of MyBabyBeginnings. We're discussing mother support groups, building counseling skills, vicarious trauma as it relates to lactation work, and so much more. With a background in social work from her pre-lactation days, Niamh brings a sense of order to what lactation counseling requires and a gentle but firm rreminder of what can happen when we don't prepare ourselves to manage vicarious trauma experienced in our line of work. This episode is sponsored by Evolve Lactation Community.
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