Lactation Consultants: Supporting Breastfeeding and Chestfeeding Parents

When first-time mother Daniella delivered her daughter Julia Rae in January this year, she couldn't wait to get home. She and her husband had visions of a blissful first weekend with their newborn that included an easy transition to breastfeeding.

Instead, four days later, Daniella found herself in the pediatrician's office-scared because Julia Rae had lost 9 percent of her birth weight.

"Even though Daniella was producing enough milk and Julia Rae would eat for 45 minutes to an hour, she wasn't getting enough," says Kama Palmer, IBCLC, a lactation consultant at Emory Johns Creek Hospital. "She was jaundiced at birth, so she got tired quickly. She was exhausted and burning so much energy to eat that she couldn't gain weight."

Within a few more days, Julia Rae also stopped latching on correctly, making the problem worse. That's when Palmer and the other lactation consultants in Emory Healthcare's comprehensive lactation consultation program-Leigh-Anne Skinner, IBCLC, Lori Harris, IBCLC, and Trisha Atkins, IBCLC-stepped in to create a plan.

They recommended Daniella try triple feeding, a mixture of breastfeeding, pumping and supplementing every three hours. Triple feeding gradually increases the amount of time a baby breastfeeds. It's intended to be a temporary process. But it took several weeks longer for Daniella and Julia Rae, Palmer says. Still, Daniella never gave up.

Thanks to those weekly sessions, Emory's breastfeeding support group and the breastfeeding help line, Daniella reached her goal. Since the beginning of March, she's exclusively breastfed Julia Rae.

"I've never seen someone work this hard at breastfeeding. She persevered because she wanted to breastfeed so badly," Skinner says. "Every week when she came in, we encouraged her to breastfeed for just a little bit longer even when she felt like nothing was changing. Now, she's so glad she stuck with it."

What Is a Lactation Consultant?

Breastfeeding or chestfeeding may be your body's way of nourishing your newborn, but it does not always come naturally. If you have trouble, a lactation consultant can guide you. These health care professionals specialize in helping lactating parents successfully breastfeed or chestfeed their babies.

Lactation consultants complete 45 hours of training to earn their license as certified lactation consultants (CLCs). International board-certified lactation consultants (IBCLCs)-like Emory Healthcare's consultants-complete an additional 50 hours of training.

To earn their license, IBCLCs must:

• Complete 90 hours of education on breastfeeding, nutrition and anatomy
• Offer at least 1,000 hours of breastfeeding/chestfeeding help to lactating parents within three years
• Pass an exam
• Complete continuing education courses yearly
• Earn recertification every five years

What Does a Lactation Consultant Do?

You may first hear about breastfeeding/chestfeeding from your obstetrician. They might talk with you about whether you want to try it, or they could recommend you attend prenatal classes to learn more. Your doctor may also suggest that you schedule a one-on-one appointment with a lactation consultant before you have your baby.

When you are in the hospital after delivery, a lactation consultant will visit you within a few hours to teach you how to hold your baby and position their mouth on your chest for a proper latch. They will give you tips on the best posture so you can sit comfortably while your baby eats. And if you need (or prefer) to pump your milk, the consultant can show you how to use a breast pump and check to see if it fits you correctly.

Most importantly, Skinner says, your lactation consultant is there to support you, answer your questions and troubleshoot any problems you have.

The Emory Lactation Consultation Difference

Most hospitals offer lactation consultation services to new lactating parents who are still in the hospital. But the Emory lactation consultation program stands out because it provides a culturally sensitive, patient-centered focus, Skinner says. Rather than follow the same checklist with every new parent, our lactation consultants personalize each visit. And our team understands and supports the choices every family makes. Whether or not breastfeeding is the right choice for you, we're here to help however we can and however you need us.

"At Emory, we can take extra time with mothers. If you're a new mom, we ask about your breastfeeding goals and what's important to you. And we offer evidence-based clinical information to make breastfeeding easier," she says. "Our lactation consultants are here to support you. We help you do what's best for your family without guilt or shame and without imposing our own bias. That's something unique to Emory Healthcare."

Our program also offers daily in-person and telephone outpatient consultations. Palmer says she and her colleagues see at least three lactating parents for visits every day. In-person visits can last an hour or more, and phone calls typically last a half hour.

"If a mom is in my office, I can watch her baby latch, see if she needs help transferring from one breast to the other or determine if her breasts are overly full," she says. "I do an equally thorough assessment over the phone, asking about the mom and baby from head to toe."

Palmer says our lactation consultants also contact pediatricians to make any necessary feeding recommendations.

What Happens During a Consultation?

Before every lactation consultation, Skinner says she reviews the new parent's health history to identify anything that may delay milk production. Several factors can make breastfeeding harder, including infertility treatments, biopsies, obesity, hypertension, or even being an older mom.

During these one-to-two-hour visits, Skinner says she:

• Assesses the baby's sucking reflex
• Checks the baby for a tongue tie that prevents correct latching
• Examines the baby for jaundice, which can make them sleepy and less likely to eat
• Examines the lactating parent's breasts/chest
• Explains what breastfeeding should feel like for the lactating parent
• Watches the baby latch

Common Breastfeeding/Chestfeeding Challenges and Questions

Every new parent's experience is unique. In fact, just like the hurdles Daniella experienced with Julia Rae's poor latch and low energy, the process can be different for a parent with each child. But Skinner says these challenges happen frequently:

• Unrealistic expectations: Unlike labor, delivery and epidurals, people spend little time researching breastfeeding/chestfeeding. They may believe it will be easy or that they will be able to sleep through the night soon after childbirth. This incorrect information can increase frustration when breastfeeding/chestfeeding is difficult.
• Painful latch:Babies are not born knowing how to latch onto your chest. They are learning just like you. An incorrect latch can feel like a pinch each time your baby sucks, and it can lead to cracked or sore nipples.
• Clogged milk ducts:When the tubes that carry milk from your breast tissue to your nipples don't drain properly, the tissue gets irritated, blocking your milk supply. You develop a painful lump and may see swelling. Clogged ducts happen when something prevents your milk from leaving your breast, like skipping a feeding or an incorrect latch.

Even if you have breastfed before, it is OK to ask questions. Palmer says she frequently answers these questions:

• What is the best position to breastfeed?
• How can I get my baby to latch correctly?
• Why do my nipples hurt, and how can I make them feel better?
• Is my baby eating enough?
• How can I boost my milk supply?
• How long should I let my baby eat on each side?

Emory Healthcare Breastfeeding Classes

Whether you are a first-time or experienced mother, you may need help with breastfeeding. In addition to support groups, our lactation consultation program offers in-person and online classes on Breastfeeding Basics, Pumping and Returning to Work.

If you are interested, check the schedule and sign up for a class.

Have questions or need help with breastfeeding? Our lactation consultants are ready to help. Request an appointment with our program.

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