Lactation consulting has emerged as a new field over the past twenty years. Because scientific inquiry has consistently shown breastfeeding to be the recommended source of nutrition for infants through the first year of life, more mothers are opting to nurse their infants. Lactation consultants try to meet the educational needs of these mothers and sometimes of other health care providers who have an interest in their patients' breastfeeding needs.
Lactation consulting is the only specialty within health care that places the advocation of the woman who wishes to breastfeed her baby as its primary responsibility. The mother and her baby are described as a nursing couple or a nursing dyad—two separate people forming one unit. If other members of the health care team choose a plan of care that could be detrimental to the nursing dyad relationship, then the lactation consultant may need to suggest an alternate course if one is available.
Caring for the mother and baby
The primary function of the lactation consultant is to gently guide the mother's breastfeeding in a manner that involves the least intrusion and generates a minimal amount of complications. The consultant's skills are based on scientific information and familiarity with breastfeeding.
A useful approach for the consultant is to make suggestions to the mother while explaining the rationale behind these recommendations. The mother can then determine how to adapt these recommendations to best promote her needs and the needs of her baby. Potential problems that a lactation consultant would assist a client with are nipple soreness, breast engorgement, and milk production. A lactation consultant should be knowledgeable in the various components of science of lactation: milk production, normal breastfeeding behaviors, and factors that may impact the breastfeeding relationship.
Lactation consulting can occur in a variety of settings—within the hospital, in the home, in a clinic or
Every postpartum mother who is breastfeeding should ideally be observed feeding her newborn at least one time prior to being discharged home. In the hospital setting, the role of the lactation consultant is to observe every mother breastfeeding and to ensure that maternity staff receive training in basic breastfeeding management and common problems and are capable of making such observations. The maternity staff can then refer complicated problems to the lactation consultant.
Lactation consultants in the hospital setting also act as an advisor in the development of breastfeeding policies and procedures for the facility. The consultant may compile handouts and other reading resource materials for breastfeeding mothers, as well as design forms for documentation of breastfeeding activities. If the nursing mother needs to use a breast pump or other breastfeeding device, the consultant may be the one responsible for assisting the mother in obtaining the equipment and training the client in its use.
There are several outpatient facilities that the lactation consultant might practice in. Some of these are public health clinics, health care provider offices, home health care, or as a consultant in private practice.
PUBLIC HEALTH CLINIC. Working in a public health clinic, such as Women, Infants, and Children (WIC), the lactation consultant will be an active advocate for breastfeeding because WIC, through the U.S. Department of Agriculture (USDA) has undertaken a breastfeeding promotion program. WIC participants represent a significant proportion of the low income and at-risk population of women and infants. The WIC program is having an impact on meeting the Healthy People 2010 breastfeeding goals for the United States. Women who are breastfeeding in the WIC program receive priority treatment and additional services. The breastfeeding mother will receive an enhanced food package including additional fruit juice, dairy products, legumes, carrots, and canned tuna fish.
In the WIC program, the lactation consultant may be responsible for the training of peer counselors. Peer counselors are individuals of a similar background as other WIC clients who have breastfed or are breastfeeding a child and have an interest in supporting other mothers to do the same. WIC clients come from ethnically diverse backgrounds, and peer counselors are particularly useful in expressing sensitivity to the different cultures, socioeconomic backgrounds, and value systems. WIC uses peer counselors to promote breastfeeding and lactation consultants to manage breastfeeding problems.
HEALTH CARE PROVIDER OFFICES. In the clinic/office setting the consultant will conduct prenatal education in breastfeeding, will make rounds in the hospital on patients who have delivered and will provide follow-up after discharge through home visits and a telephone help line sometimes referred to as a "warm line." The lactation consultant in a health care provider's office will serve as a resource person for doctors and nurses by providing updates on breastfeeding research and information on medications that are contraindicated for the mother to take while breastfeeding.
HOME HEALTH CARE. If a mother is discharged prior to 48 hours after delivery, the home health visit is particularly important for assessing proper initiation of breastfeeding. The lactation consultant making such a visit may also be a registered nurse and will be checking the mother and baby for recovery and transition, in addition to breastfeeding. As part of such an assessment conducted by a registered nurse, certain phenomena should be observed. The infant should be having at least six wet diapers and four stools a day after the milk is "in." The mother's bleeding should be decreasing, she should not have a temperature—be afebrile—and any incisional discomfort should be under control with proper medications. The home assessment may involve taking vital signs on the mother and the infant.
Relatives and siblings may make for a hectic environment as compared with another setting, but the home environment allows for a more realistic environment in which to observe breastfeeding, and the consultant also gets a view of the client's support system. Involving family members in breastfeeding education will help relatives to understand the benefit of breastfeeding and may prompt a more supportive environment for the mother. The lactation consultant may wish to encourage the mother to make use of a telephone help line if she has any problems and concerns that were not addressed during the home visit.
PRIVATE PRACTICE. A private practice affords the lactation consultant the greatest flexibility but simultaneously constrains the consultant with more administrative
responsibilities. The independent lactation consultant may operate out of a home office or maintain a regular office, possibly sharing it with other consultants or heath care providers. The source of referrals for the independent lactation consultant is from clients themselves, from other lactation consultants, from other health care providers, and from hospitals.
Education and training
The field of lactation consulting attracts people from a varied background. Some hold advanced degrees in medicine, nursing and nutrition and have been working in maternal child health. Others are lay counselors who obtained the necessary education to become lactation consultants after having had a positive breastfeeding experience of their own.
Professional education for lactation consultants was first offered in the early 1980s. The International Board of Lactation Consultant Examiners (IBLCE) started to offer a certification exam for lactation consulting in 1985. Shortly thereafter, the International Lactation Consultant Association (ILCA) became the professional association for lactation consultants.
Consulting—Providing advice or an opinion.
Lactation—Secretion of milk from the breasts; the act of breastfeeding.
Kutner, Linda., Barger, Jan., and Peterson, Carole. "The Lactation Consulting Profession." In Counseling the Nursing Mother: A Lactation Consultant's Guide, edited by Lauwers, Judith., Shinskie, Debbie., and Breck, Sandra. Boston: Jones and Bartlett, 2000, pp.7-23.
The International Board of Lactation Consultant Examiners (IBLCE). 7309 Arlington Blvd., Suite 300, Falls Church, VA 22042-3215. (703) 560-7330. <http://www.iblce.org>.
The International Lactation Consultant Association (ILCA). 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. (919) 787-4916. <http://www.users.erols.com/ilca/index.html>.
Nadine M. Jacobson, R.N.