What is a Lactation Consultant? – Inkredible Birthing

Years ago we didn’t have Lactation Consultants. People had their babies in hospital, or at home, and the baby was put to the breast and that was that; Breastfeeding your infant. Or was it? It’s hard to know for sure how many people in the past continued with breastfeeding after their care by nurses and midwives ended. Did they move to formula feeding when it was available? Were they having problems and just didn’t tell anyone? Or maybe they were some of few of the lucky ones that didn’t have any stumbling blocks with breastfeeding.

There was a lot of time in our recent history where many people just didn’t talk about the difficulties they had, with breastfeeding or anything else. With formula available, it was easy to switch over to a bottle and simply not mention any struggles. I think this lack of communication contributed to the idea that breastfeeding is easy, simple and if you had problems, you were the odd one out. Don’t speak about it! Only, please do speak about it, because if we don’t know about each other's struggles, we can’t really know what’s normal and what isn’t.

There has been documentation throughout history of women having difficulty with breastfeeding. Their option wasn’t formula feeding, but they did have an alternative: the wet nurse. It wasn’t uncommon for women to feed each other’s babies. They helped feed if there were difficulties, if the birth mother was ill, if suddenly not producing milk, or if they didn't survive childbirth. It even became fashionable among the upper class nobility and royalty in many european-based countries to not feed your own baby yourself, but employ a wet nurse to do it for you.

There is documentation that wet nurses existed even in 2000 BC. It was noted in an entry of a ‘Lactation Failure’ and a recipe for increasing milk supply from a medical-like journal from Egypt around 1550 BC (cite).

With this knowledge, it seems like that even thousands of years ago, breastfeeding did not come ‘naturally’ to everyone. But how did the Lactation Consultant start coming into the picture? You could say it started with the rise in formula use in the 1940s and 50s, or more accurately as a result from the rise in formula use. Formula is such a great invention for those women who are unable to breastfeed themselves, due to adoption, lactation issues, HIV status, trauma and multiple other reasons, as well as it being a fast, nutritious food for the ill or in-need-of-calories infant. However, with formula readily available to everyone, considered safe and even by some companies, better than breastmilk, a very lucrative market appeared for feeding products. Those companies could sell more than just formula, and like many other times, greed and profit started to outweigh the best interests for mothers and babies.

This increase of formula use, while incredibly helpful for those that really needed it, offered an alternative feeding practice that was, in actuality, easier to get the hang of than breastfeeding. With this ease, came more formula being bought, and then more greed within the companies making a profit. There is a black stain on the formula companies for their history with the exploitation of poor countries, sweeping in with sales girls dressed as nurses, spouting that formula is better than breastmilk and that everyone should be using it. They were seeking profit, and at the expense of mothers and babies, which put those children at huge risk of malnutrition and diarrheal diseases. Their mothers tried to do what they thought was best, but they were unable to afford the correct amount of formula or able to provide clean water to make it. The World Health Organization created an International Code for Marketing Breastmilk Substitues (cite) just to combat this problem. However, a whole generation across almost the entire globe had a disruption with exclusive breastfeeding.

With this disruption, we lost a generation who knew how to breastfeed, and could help the younger, newer generations with problems that might arise. This lack of visibility, not watching your elders breastfeed and solve problems, meant that when it was your turn you didn’t have anyone to ask questions or lean on.

Without having that support, it’s more and more likely that when things don’t work, you’d move to formula. It’s easily accessible, and safe - depending on which country you live in, of course.

Now a second generation has gone by without having exclusive breastfeeding, and the next one is becoming the age where they have to feed their own children. Only now, we know of the incredible benefits that breastfeeding has, that it’s more than just nutrition, but a living thing that changes with every contact with your baby. More and more new parents want to breastfeed, and their community supports are limited. Their parents and grandparents may have breastfed, but more likely they attempted to, and then just went to formula. There are some breastfeeding groups, like La Leche League International (a most fantastic resource), that have popped up to help each other with breastfeeding problems. Some groups are more welcoming than others, some have more information and resources than others, but some advice and support provided in one may contradict the other. This is where the Lactation Consultant really starts to appear in our history.

Lactation consultants, lactation educators, breastfeeding support workers and others working as persons specialized in breastfeeding, started to arise as professionals in the 1970s and 80s. This was in response to people wanting more support with their breastfeeding journeys and people in the maternity field or with breastfeeding experience were doing their best to provide it.

In 1985 the International Board of Lactation Consultant Examiners, IBLCE, a credentialing body dedicated to increasing and promoting breastfeeding and lactation worldwide, started the International Board Certified Lactation Consultant examination. This was designed to ensure professionals working in the field of lactation all had the same knowledge, judgment and skills and therefore were able to offer top-standard care. IBLCE was supported by La Leche League International in their beginning phases, and now has about 37,000s IBCLCs in 134 different countries.

That is a big number, but considering the population of the world, that’s a small number of people who hold the certification in relation to the amount of birthing people and newborns in the world. There seems to be a large demand for LCs throughout the community, and a few LCs offering services.

Being an RN, it was a simple process for me to consider continuing onwards to being an LC. I had my healthcare profession, I already worked in maternity and newborns, had breastfeeding education and experience behind me from my work. I didn't think it was out of my way to increase that knowledge and skills and prepare to write my exam. The amount that I had to work on was pretty staggering, though. I needed a couple hundred hours of education and over a thousand hours of hands on work with breastfeeding dyads in order to qualify writing the exam. Even starting out as an RN with breastfeeding experience, I had to go out of my way to work more and learn more. I’ve known a few other IBCLCs, and most of them either work in a hospital breastfeeding clinic, which can be very limited, or they don’t work outside of their general maternal/child unit. Very few RNs become IBCLCs, and those that do, even fewer of them move on into community style work.

A hospital breastfeeding clinic is generally for those persons that have delivered at the hospital, have been discharged and then have a follow up appointment for weight or bilirubin for the baby. Sometimes the LCs will visit those new parents on the postpartum unit, depending on their time constraints in the clinic. The demand for these clinics are high; many parents are seeking assistance with breastfeeding from LCs. More and more parents want to breastfeed long term, and wish to have questions answered or assessments done. Hospital clinics are unable to meet this demand. Many people try to seek out private LCs, but if they are unable to find or afford one, they will often struggle alone. Sometimes, they might join a La Leche League or other breastfeeding mothers group if they feel accepted and comfortable, but more often than not fall back to formula even if that’s not what they wanted. In Canada, about 90% of all new parents start breastfeeding and 80% are exclusively breastfeeding within the first week. That number drops dramatically to 56% at 4 months, and 34% at 6 months (cite). Even within my own practice in Labour and Delivery, when asked if patients want to breastfeed, the answer is generally ‘yes’, but that ‘yes’ comes with a lot of insecurity, a lot of concern that they won’t be able to.

There are good intentions with starting breastfeeding, but then something happens between 1 week and 4 months, that nearly half of all breastfeeding mothers stop exclusively breastfeeding. A portion of those will be parents that have made the decision to combo feed or switch to formula for other reasons, and that’s perfectly alright, but for those that want to exclusively breastfeed, there are complications, difficulties and struggles that are being missed.

This is where the Lactation Consultant comes in. A Lactation Consultant specializes in issues with latch, tongue ties, milk supply, emotional support through breastfeeding, pumping and even with bottle feeding. Lactation Consultants support the parents to feed their babies in the best way that works for them. Some parents want more support for exclusively breastfeeding, some want support in learning how to pump for the NICU baby, other parents want to make sure that they are choosing the best kind of formula and products for their babies. LCs can help wade through all the information.

Another question people often ask is why private LCs are so expensive? Partially, it’s because they are usually small business owners, and so are trying to cover all of their overhead costs, make sure they set aside enough for taxes, still get a fair compensation for the time spent with clients, along with all of the extensive education and continuing learning that they have to do to keep up their IBCLC. Good news is, more and more insurances are starting to cover Lactation Consultants, though if your LC is also an RN, sometimes they can bill under Private Nursing Services, to help with the costs.

Your LC should make you feel comfortable with your choices to feed your baby, they are there as a resource of information, someone who has physical skills to teach, is able to meet you where you are and help reach your goals for feeding. You should not feel pressured to exclusively breastfeed at the breast with an LC, and no one should make you feel guilty or shameful for how you choose to feed your baby (provided that you are feeding your baby, but if you aren't that’s a whole other issue). There are a lot of things that a Lactation Consultant would be able to help you with, whether you are struggling with breastfeeding or learning to pump or deciding to formula feed. LCs can offer more professional assessments beyond mother-focused groups and offer more support and services beyond what your hospital may be able to do. If you’re thinking that an LC might help you with your feeding journey, I encourage you to look into them more and see if they would be a right fit for you!