5 Things Your Hospital Lactation Consultant Wishes You Knew

1. She Cares About Your Family

Before she even enters your room she has already combed through your chart, familiarized herself with your health history, any medications you may be on, how your labor and delivery went and in most cases discussed or received a report from the nurse who has been taking care of you and your brand-new baby.

2. She Is Spread Thin

She aims to see every family on the floor, whether that's 3 or 23 in her shift. That includes charting everything that is discussed and happens during each consult. Most hospitals do not employ Board Certified Lactation Consultants full-time. The majority are part time which means their shift may last anywhere between 4 to 8 hours . Hospital lactation consultants not only see the families on the postpartum unit, they are required to see anyone in the hospital who requests a consult. This includes labor and delivery patients, pregnant patients on antepartum who are staying in the hospital on bedrest, and families with babies in the neonatal and pediatric intensive care units. If there is a patient anywhere else in the hospital that is breastfeeding and has requested a consult with the hospital IBCLC, she will have to make her way to the unit where that mother is staying at some point during her shift. If the hospital has an outpatient breastfeeding clinic, she would need to see those patients as well. For hospitals that do employ IBCLCs it is almost unheard of for there to be more than one on any shift. So when she comes to your room and you ask her to return later because you are having your lunch, your family is visiting at that time, or you really want those super cute newborn pictures, you may not see her again. You may be waiting until the next shift for someone else to show up, that is if there is a second shift that day. If this happens on a Friday, there may be no weekend coverage and you could go home without ever receiving specialized assistance.

 3. She Hopes You Take That Breastfeeding Class

Preferably taught by a local IBCLC or Certified Lactation Educator, these should be full length 2-3 hour classes. In many communities you may be able to find free or low cost classes. All classes must be covered by your insurance company. In some cases you may have to pay upfront and submit a claim form. For many parents the first time they even see a breastfeeding baby or get any breastfeeding education, it is after the birth of THEIR OWN CHILD. For anyone that has given birth to a baby you may know that the immediate postpartum period is probably not the best time to acquire new information. The more you understand before birth about normal newborn behavior, what to expect in the early days, how milk production works, and how to tell if baby is getting enough, the easier this transition to parenthood will be.

4. She Is Advocating For You And Your Baby

In many hospitals across the country hospital IBCLCs can very well be in the minority when it comes to supporting the breastfeeding efforts of families inpatient. She may be getting flack not only from the attending pediatricians and neonatologists but from the nursing staff. In optimal situations, your health care team can work collaboratively to support your wishes and needs but sometimes there is pushback when it comes breastfeeding. Especially in instances when babies have higher than average bilirubin levels (jaundice), lower blood sugar levels, or may be loosing more weight than a particular provider deems acceptable-even if these levels are well within normal limits according to hospital protocols. (Most babies whether formula fed or breastfed loose between 4-10% their body weight in the first 4 days of life. This is normal in the majority of cases.) 

You can bet your hospital IBCLC has definitely gotten her ass handed to her at some point in her career by a pediatrician, a neonatologist, an OB, or a specialist simply for implementing a plan of care based on current clinical evidence. If your pediatrician has ordered any supplementation for your baby, even if your IBCLC does not agree or finds that these orders go against hospital protocol, she cannot say a word to you that conflicts with what your pediatrician or the attending pediatrician has already advised.

If you have ever felt like your baby had a tongue tie that went unnoticed while inpatient, please know that many hospitals have gag orders not allowing IBCLCs to discuss their findings with the patient when it comes to tongue tie. As we are not credentialed to diagnose. We can asses whether it walks, talks, acts like a duck...but only your care provider can diagnose if it REALLY is a duck. Even if he or she has zero education on duck diagnosing.

  Though it is improving, many pediatricians and residents do not receive any lactation training during medical school or beyond. Their scope is broad. Unless they have sought out continuing lactation education, chances are their knowledge on the subject is limited.

5. She Does More Than Just See Patients

In a 'Baby Friendly' facility all staff must be trained in the normal course of breastfeeding and how to assist families that choose to breastfeed. Hospital IBCLCs are in many cases, responsible for training the staff. They are almost always involved in education initiatives, breastfeeding advocacy within the hospital and beyond, and may also hold weekly support groups. In a baby friendly facility, breastfeeding families also need to be followed up with a phone call within 2-4 days of discharge. Hospital IBCLCs may also be responsible for teaching community childbirth education, breastfeeding, and newborn care classes.

Although sometimes you may not get the lactation support you need during your hospital stay, it is unlikely because your IBCLC did not want to see you. As you can see, most simply have too much on their plates. Complaints to managers about disparities in care due to inadequate staffing, do not usually get far. What hospital employees have to say to their administrators pales in comparison to what YOU have to say. Services are driven by patient satisfaction. If you did not receive the attention you needed, when that hospital Press Gainey Survey comes in the mail please fill it out. Let the administration know what you had hoped for, what was promised on your hospital tour, especially if the facility had received the Baby Friendly designation (hospitals with this designation have no obligation to have even one IBCLC on staff). And if you did receive great care, please let them know as well. We depend on you to maintain the privilege of continuing to serve our communities in our local health care facilities and to increase the level care offered. And if you are not satisfied with the care you are receiving inpatient, speak up. Not all hospital lactation consultants are board certified. Some staff members calling themselves 'lactation consultants, counselors, specialists', or 'lactation nurses' may actually have little education and experience in the field of lactation. You can only be assured of the highest standard of clinical care and experience when you are working with an IBCLC (international Board Certified Lactation Consultant). You can always ask if your consultant is an IBCLC, and ask to see her credential (she should be wearing it along with her hospital ID at all times).

 IBCLCs do not get into the profession hoping to get rich. I think can speak for most of us when I say we truly care for the families we work with. We want you to reach all of your goals and to enjoy your new baby. If you are experiencing any feeding difficulties after a hospital birth, request that your RN order a consult for you. If these issues persist after discharge, seek out assistance from an IBCLC in your community. Breastfeeding should be enjoyable for both you and baby. If it is not, we can help!