What is an IBCLC and why might you hire one?

What is an IBCLC, and why might you want to hire one?

In many parts of the world an IBCLC, or International Board Certified Lactation Consultant, is a fairly standard part of perinatal care. Certainly in places like the US where health care is private you would likely have access to an IBCLC covered by your insurance plan. However, here in the UK its highly unlikely that your local NHS trust employs even one IBCLC. Its even less likely that the majority of parents would recognize when they may need this extra support, nevermind know where to find someone able to give it! Even if you know what an IBCLC is, and where to find one, you are quite likely to come across opinions such as “you don’t need to pay for breastfeeding support.” Or “If they were that good they’d be available on the NHS.” (Like osteopaths… oh… wait… hmm.) According to a quick poll over on Breastfeeding Twins and Triplets UK, around a 3rd of those who responded didn’t know the difference between an IBCLC and other breastfeeding support.

So lets begin by explaining exactly what an IBCLC is. According to the International Lactation Consultant Association:
“An International Board Certified Lactation Consultant ® (IBCLC ®) is a healthcare professional who specializes in the clinical management of breastfeeding. An IBCLC is certified by the International Board of Lactation Consultant Examiners ® (IBLCE ®), independently accredited by the National Commission for Certifying Agencies (NCCA) of the Institute for Credentialing Excellence (ICE). An IBCLC works in a wide variety of settings, providing leadership, advocacy, professional development, and research in the lactation field.”
 
Thats a whole lot of words to basically say that an IBCLC is a breastfeeding specialist who works in different places, including hospital and community. So what actually makes us “specialists” anyway? Well, becoming an IBCLC is no walk in the park. It’s not something you do by attending a weekend course – its a huge commitment, and meeting the criteria to even sit the exam takes a minimum of 2 years – if you’re quick, have access to money (or, ahem, your husband’s credit card) and someone like the afformentioned husband is willing and able to keep small children out of your way while you study. This is going to take some explaining…
First up, you have to meet the prerequisites. Before you even think about applying to sit the IBLCE exam you need to either be a recognised health care professional, such as a nurse or Doctor, or (like me) you need to run around like a crazy person collecting 14 (yes, FOURTEEN) Health Science Courses at college level. These courses are:
Biology
Physiology
Anatomy
Psychology
Growth anddevelopment
Nutrition
Sociology
Clinical research
Basic life support
Medical documentation
Medical terminology
Occupational safety for health professionals
Professional ethics
Universal safety precautions and infection control.

IBLCE don’t offer a course to complete all of this. You have to go out and find your own courses, in your own time. Plus, IBLCE won’t even verify if a particular course meets their criteria, so you are often stabbing in the dark and hoping you’ve found a good one. Its stressful, expensive, and very time consuming.

The next thing you need is a minimum of 90 hours Lactation Education, from an approved provider. The face to face ones in the UK are few and far between, but they do exist. They usually meet for one day a month for an entire year. The online ones are self paced  – I completed mine online in 3 months – using a lot of my annual leave from my then job. These training programs are very in depth. We have to cover how to support preterm babies, mothers without very much breast tissue or who have had surgery, babies who need special care… we have to know a thing or two about how drugs enter the milk supply, breast abscess, allergies, everything under the sun that might make a nipple sore (hint: there are a lot of things that might make a nipple sore), relactation or inducing lactation, pumping, feeding a baby who can’t latch, assess suck function, know roughly what a tongue tie looks like, be able to notice a high palate, how to support transgender or same sex families, know about and respect the feeding practices in different cultures… and then there are the counselling skills – from your everyday “how do you feel about that top up?” To “I’m so sorry about your loss – what was your baby’s name?” All of that is crammed into 90 hours of classroom or online education, and is backed up with reams of recommended reading. I read 4 text books to prepare for my exam. Each one was around 800 pages long, and each one covered nothing other than lactation. That is a LOT of information about breasts, babies, and milk.

Next up you need 1000 hours of experience supporting families. And someone willing to vouch for you. These hours need to be through a structured service – you don’t get to just randomly go to baby groups or your mates houses and call it an hour or 2. You have to volunteer or work through something like the NHS, a peer support charity, or one of the big 4 UK breastfeeding charities. IBLCE will give you 500 hours a year automatically if you do your hours with one of these recognised bodies – I’ll admit I think its a weak point in the certification, but at least in my case I am confident that I did genuinely have over 1000 hours of supporting time behind me when I applied for the exam.

Finally, you get to apply… possibly sit through an uncomfortable two weeks if your application is selected for audit, and then… well then you spend six months studying because £500 is a loy of money to throw away if you fail. IBLCE are very clear that we aren’t allowed to talk much about the exam – its like Fight Club for Breastfeeding. But I can tell you its 4 hours long and it reduced me to tears. Me, who scored very nearly 91%. It messes with your head and its made worse by the AGONISING nearly 3 month wait for the results.

And THEN, after we pass and set up our insurance and start seeing clients, we have to recertify with continuing education credits at 5 years and by sitting the exam again at 10 years. Even Nursing doesn’t require you to resit your exam every 10 years, but IBCLCs have to in order to maintain our credential.

So, thats what an IBCLC is – an incredibly qualified individual when it comes to breasts and milk. We have well and truly proven ourselves to be allowed to use the title IBCLC (and yes, I make sure all my post is addressed to Lucy Ruddle IBCLC after all that damned work!) To put this into perspective, the average GP has attended one seminar on breastfeeding. Your average Midwife is doing considerably better, but its unlikely they’ve had training (or are given the time) to support anything remotely out of the ordinary. Which is where in other countries the IBCLC would enter the scene. Here in the UK, that is rare. Instead you have to figure it out on your own and, if you have the money, you may decide to find and hire one yourself. IF you know we exist and how we’re different from other support.

A peer support group is Mothers who have had some training (generally several hours) to offer support, information, and a friendly ear regarding common worries. They can probably spot an iffy latch, and a skilled Peer supporter can help you tweak it. They can tell you where to get more info if your GP has said you can’t take a certain medication, and they can share their own experiences with you.

A Breastfeeding counsellor has had about 18 months – 2 years of training and their main bag is to counsel mothers. You don’t call one of the national helplines (which are all run by BFCs) and have a question answered in 2 minutes. They give you a safe space, hear your story, and then make suggestions. They know about self help for mastitis and thrush, how to express, they can help you with a baby that isn’t latching well, and they know where to signpost you for more support.

And THEN we come to IBCLC. Often the last resort in the UK. When no one else knows how to help you, we may be invited to offer up our skills. Would breastfeeding be easier if we could support as standard on the NHS? I think it would, but thats nothing more than my own opinion. As it stands, we are there for you if you have exhausted all other avenues, or, for the aware few, if you can afford to have us in during the first week to catch any problems before they develop. We are very well qualified – we HAVE to be to call ourselves IBCLC. We are not money grabbing monsters trying to take advantage of new mothers. We have a unique and rare skill set we have dedicated years to acquiring – and we live in a country that doesn’t deem lactation support important enough to be available courtesy of our free at the point of contact health service… I wonder why our breastfeeding rates are so low?

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The importance of physical closeness with your baby during relactation.

Relactation is something I spend a lot of time talking about. It’s something I have done myself, it comes up a lot during my time volunteering for a National Breastfeeding Helpline, and I run a facebook group dedicated to building and rebuilding milk supply; both for those wanting to relactate, and people choosing to explore induced lactation as well. I am frequently asked about how to relactate. How often to pump, how to set the pump to the best suction, whether pumping at night is really that important, how long it will take, and whether galactagogues are worth it. Its very natural I think, when embarking on a mission to return to breastfeeding that you would focus on what you can measure – so the amount of milk dripping into a bottle, or the number of minutes spent attached to a breast pump. What we seem to often forget with relactation is that it’s not really about the milk. Really, it’s not. When I ask Mums why they want to relactate – which, lets be blunt here, is am intensive long haul marathon that takes over your entire life for months at a time – they initially say things like “It’s better for my baby” or “I don’t think formula suits her” but when I dig a little bit deeper what often comes up is “I miss the feelings of closeness” or “I miss being able to comfort him in such an easy way.” We can all agree, I’m sure, that closeness and comfort have very little to do with the actual milk, and a lot to do with how being held so very close to someone’s skin actually feels. This isn’t to say that parents who bottle feed their babies aren’t connected to their babies, or they don’t feel well attached or close to them. That is absolutely not where this post is going. My point is simply that for many Mothers (but not all) the particular type of closeness they associate with feeding their baby at the breast is something they miss when breastfeeding ends. With this need for connection and closeness in mind, I want to explore how over on my facebook group we encourage and support Mums on their relactation journey by working with them not only on the technical side of rebuilding a milk supply, but also on the stuff that is often overlooked because it doesn’t yield immediate and measurable in ML results.

Lets take skin to skin as our first example. If you consider breastfeeding for a moment, you can see that it very clearly requires some degree of skin to skin contact. I’m not talking about the nappy off, half naked Mum type of contact we encourage for all sorts of reasons (ALthough that’s awesome too – ALL the skin to skin please!) I’m talking about a cheek against a bare breast, a chest touching a chest, a hand intertwined with another. This little dance takes place 8, 9, 10, even 12 times a day when breastfeeding. It is also the very first thing that usually stops when breastfeeding ends. It is this closeness – this frequent, prolonged skin to skin contact with its associated oxytocin release, that many Mothers say they miss the most when we break their feelings down. The truly wonderful thing here though is that we can quickly and easily bring back skin to skin at feeding time with a bottle. Mum simply undoes or removes her bra as though she is going to breastfeed, and she holds the bottle as well as her baby close to her breast. Baby will be fairly upright,and this is the perfect position for paced bottle feeding too (which also helps babies during relactation.)Feeding baby in this way achieves 2 things – firstly, as already suggested, it reintroduces the closeness Mum may feel she’s missing through bottle feeding, and secondly we begin to gently and safely remind baby that the breast is where we get milk. For some babies who have had a gap in breastfeeding, returning to at breast feeds can be stressful or overwhelming. If we have kept up the message that feeds happen at, or at least near the breast then it can often make that transition easier.

Next I want to talk about Co-bathing. This is the practise of running a fairly deep bath and getting in with your baby, holding him against your chest and upper stomach so his body is partially covered with the water. This is often suggested to Mothers with a full milk supply whose babies are struggling to latch – but that isn’t always our aim in this situation. Warm water and the closeness to Mum’s body seem to combine to take baby back to the moments after birth. She may reawaken her innate knowledge and wisdom about how to breastfeed, because the water, the warmth, the smell of Mum, and the Oxytocin let her reflexes resurface. She may knead the breast with her hands, bob her head around, root, lick Mum’s nipple, or even attempt to latch. All of this is wonderful – but what is also wonderful is if she simply places her cheek to Mum’s chest, and gazes into space for several minutes while she rests there, drinking in the feelings of safety and warmth. Once again, this is because baby is learning to feel safe near the breast. Learning to feel relaxed, so that when it comes to attempting a latch, it’s far more likely to go well.

Baby wearing is yet another way to bring about closeness between Mum and the not yet breastfeeding baby. Baby wearing skin to skin is even better. So is baby massage, and finger play rhymes, sharing books, singing songs, a two way communication with baby while mum gazes deeply into his eyes. It all builds connection and closeness,it all recaptures part of what Mum wants to build on – what she misses about breastfeeding. This is just the beginning though. What is so very interesting here is I have noticed that often when Mum relaxes and begins to enjoy these little rituals – the bottle feeding skin to skin, the bathing, the massage, the stories, the slings… firstly she worries less about whether or not she can succeed at full relactation, which then leads to feelings of wellbeing and a sense of peace and acceptance – and, amazingly, what then appears to happen in a lot of cases is that all of a sudden the milk supply begins to increase. The wellbeing and connection with our babies is THAT STRONG that it shifts our focus away from measurable results to our feelings of love and enjoyment for our beautiful babies – and that in itself releases our fear of failure and sense of desperation, which so often unintentionally holds us back. Breastfeeding is an act of love and closeness. It needs skin to skin and it needs feel good hormones to flow. Pumping to rebuild milk supply is a labour of love, but in the intensity of it we can forget that breastfeeding is so powerful, and so effective because it’s not simply about removing the milk.

The privileged role of offering breastfeeding support.

The very early hours, days, and weeks of motherhood are deeply personal, raw, and intimate. A vulnerable and wholey encompassing bubble in which time simultaneously seems to freeze and to speed up. As a new Mother the world often feels completely different – bigger and more frightening – and yet, at the same time it can feel like everything has closed in so that all you see is you and your tiny curled up newborn. Those days are filled with both fear and awe – tears of frustration one moment and heart bursting love and wonder the next. It’s a strange, hazy time that can never be replicated or even fully explained to someone who hasn’t been there.

To be invited to share in this vulnerable and intimate window of motherhood is nothing less than an honour and a privilege. As a breastfeeding supporter I am given that privilege every time a mother picks up the phone and connects to me through the national breastfeeding helpline, arrives at group, or reaches out via social media. At what is possibly the most exposed, vulnerable, overwhelming time in her adult life so far, she has made a choice to seek support away from the often time poor health professional who have been instructing her so far. I have the luxury of being able to support her by listening with my full attention for however long she needs.

We talk a lot about the power of listening in breastfeeding support. I think anyone with an ounce of training acknowledges it as important; but still – when presented with a desperate Mum and her crying baby, the urge to fix the problem can be overpowering. We are by nature empathic and compassionate people who want to help – that’s why we give up our Monday mornings, or our Wednesday lunchtimes, or whatever, to use our skills to help mums feed their babies. This can make simply saying “tell me more” instead of jumping in with ideas and tips seem counterintuitive, and it can even go against everything we have been taught about helping others. The baby is screaming, Mum is tense, and we feel the panic and discomfort rising in our chests as we want Mum to feel better, and as the Mother inside us wants to do ANYTHING to stop the baby crying. It’s stressful, anxiety provoking, and deeply uncomfortable for many supporters.

However, when we sit back, breathe into the moment – accepting it for what it is, and give Mum our undivided, warm and loving attention, we allow her to tell her story. Yes, this is great because it gives us more information which may help with practical support (such as the Mum who told me at the end of 30 minutes of talking that “oh, by the way – I had breast reduction surgery two years ago – could that be the problem?)but it goes far deeper than that. It lets mum pour out all of the thoughts and feelings that have been spinning around in her head and clouding her judgement for days, weeks, or even months by the time she gets to us. We are often the first person to not interrupt with suggestions. The first person to sit and hear all of her story without writing notes, examining the baby, fiddling with a lanyard, or reading what the person before us wrote in baby’s red book. We don’t need to worry about the next mum on our list, or clock watch so we don’t miss handover. This is almost always a new experience for Mums who are used to 10 minute GP appointments or Midwives rushing off to help someone else.

It’s difficult to put into words the incredible healing power volunteer breastfeeding peer supporters and counsellors have by doing nothing more than listening to mum speak until she is done. We can literally change someone’s experience, their long term breastfeeding success or goals, the way they view themselves, and the choices they make by listening, and listening well. Our role as women alongside women – not as an expert – is so uniquely empowering , and we have the huge, almost sacred honour of being able to do that with every single interaction we have.

Some of the most moving, feel good support with great feedback I have given has come when I don’t have an answer to the problem the Mum is experiencing. Take for example the baby who couldn’t latch despite everything being explored with not only multiple Midwives, doctors, and Health visitors, but also an IBCLC. This left Mum with nothing left to do with me but weep as she shared her hopelessness and grief. I listened, paused, reflected, gently helped her explore her fear, and listened some more – holding a safe emotional space for her until finally, she smiled, laughed, and told me that actually she COULD carry on pumping her milk. When our heads are less full of worries, what ifs, second guesses, and doubt everything feels lighter and more manageable – even a breast refusing one month old.

The work we do, the work of listening and supporting, advocating, and exploring, is a daily miracle – one that transforms women into confident, self assured, empowered Mothers with the strength to change their experience of not only breastfeeding but also their entire transition into parenthood. We don’t always need answers or solutions because when she feels supported a woman is also empowered to trust her instincts (which alone, is often where the solution lies.) and to seek further, more specialised, specific support while feeling bolstered and valued as a direct result of our warm, unwavering focus on her, and her alone.

So, as we are given the honour of being invited into this vulnerable and intimate phase of motherhood and family life, let’s remember our privileged position as listener and space holder in a world of instructions and advice. We are empowering women to change their feelings and meet their goals every single day, and often with nothing more or less than our attention. We can dismiss our support as not enough because we didn’t have an answer, but by doing so we are missing the very point of our work – which is simply to support with empathy and positive regard. We can go so far as to change lives with our listening skills. Please don’t underestimate that.

Weightloss while breastfeeding. 

So you’ve had a baby, and now in amongst the sleep deprivation and huge life adjustment you’re looking at your body and wondering what on Earth happened? Your belly may be soft, saggy, unrecognisable, your hips have likely spread, and you feel like your bum could rival the back end of a bus. Many new mums feel they want to lose weight soon after giving birth, and it’s so very frustrating to hear “wait a few months” when you’re staring in disbelief at this alien body in the mirror. 

However, you have just grown and birthed an entire human. That takes some recovery. And if you’re breastfeeding, then you are STILL growing that human! So yes, I am going to say it. Please, just take some time to catch your breath. The weight… Well, it can wait while you establish feeding and get to know your new baby. Calorie restriction in the first 6 weeks or so could potentially cause you some trouble with milk supply, but mostly its no fun dealing with hunger when you’re utterly exhausted and still sore from birth. It’s also worth remembering that many mums lose around 1.5 – 2lbs a month in the first 6 months of breastfeeding without doing anything at all! Lactation burns around 500 calories a day (and more) so if you aren’t eating your body weight in cake, takeaway and biscuits then chances are you will either lose or maintain weight with little effort.  

There will come a time though, when you’ve had your postnatal check, you don’t feel like the walking dead anymore, and you’ve got this breastfeeding thing down. THEN it might be time to think about losing weight. Your question is probably “how?!” The Internet is full of horror stories telling you that if you don’t eat a million calories a day then you absolutely will lose your milk supply. While there is a tiny element of truth in the idea that calorie restriction can reduce milk supply, its not usually a problem if we lose weight slowly and steadily. The Womanly Art Of Breastfeeding suggests losing 1lb a week is very safe, while studies have shown reducing your calories by a quarter also has no negative impact on baby’s growth. 

If you don’t feel like going it alone, then don’t panic! Here in the UK our two biggest weight loss clubs support breastfeeding. Slimming world gives you additional Healthy Extras each day while Weight Watchers allows you up to 14 breastfeeding points each day on top of your daily allowance. You just need to tell your group leader when you join that your breastfeeding. 

Exercise is often an important part of weight loss, and you can safely work out while breastfeeding. Back in the 90s there was some fuss about increased lactic acid in breastmilk after exercise allegedly making babies fussy at the breast, but when this study was repeated with tighter controls in 2002 (Wright) it was found that the babies were just as happy to take the milk post exercise as they were before. Alongside this, a study in 1990 by Lovelady demonstrated that exercise has little effect on milk production – in fact the exercising mums seemed to have very marginally higher milk supplies. 

So, the take home message regarding dieting while breastfeeding is… Take your time, go steady, and relax. Seek support from weight watchers or slimming world if you prefer a plan or group to follow, and remember that your baby doesn’t care how wobbly your tummy is, you are the ultimate source of comfort and nutrition,  and that is a real life super power. 

Liquid love. 

When Alfie was new, and scrunched up as though he was still inside my womb, I would look at this strange little being and feel confused, or terrified, or just a bit detached from him. I was a Mother – my deflated, newly soft belly, full, heavy breasts, and overwhelming exhaustion announced it to the world. I was a Mother. It was in my maternity notes, Alfie’s red book, our hospital wrist bands. I was a Mother. I repeated it to myself hourly, because I needed reminding. “I’m a Mother now.” and I needed reminding because I didn’t Feel like a Mother yet. I felt like I was watching this little human until his parents came to collect him. I struggled with my expectations, I struggled with my new body, I was so tired I started to hallucinate. Life was a blur of postnatal appointments, no sleep, feelings of panic, isolation, and worry. 

This was life for about 3 weeks. I was muddling through, trying to pretend I felt like a Mother and hoping no one would notice that I wasn’t good enough, that I didn’t love him enough. One day I went to Asda on my own and I picked up a babygro. “Alfie would look lovely in this” I thought. And suddenly I didn’t want to be in Asda, I wanted to be at home, holding Alfie. I bought the sleep suit and hurried home. I had stopped breastfeeding a week earlier, but that night I ached to reconnect with him by feeding him at my breast. The next day I began to rebuild my milk supply, and as my breasts started to produce more milk I started to experience more feelings of love and attachment, less feelings of overwhelm, guilt, and failure. I expressed with growing love, and together Alfie and I found our way through those exhausting and life altering early weeks, feeling our way with tentative steps towards exclusive breastfeeding and all encompassing love. 

Alfie taught me that my body was worth more than hatred and punishment for its appearance. His willingness to return to my breast, the closeness I felt with him during those feeds, and the feeling that this was something only I could do for him. In a world of “let Daddy give a bottle” and paid daycare from 3 months, breastfeeding became sacred to me. 

Two tears later my journey began again, when Oliver arrived before he was ready  into a bright hospital theatre, cleaned and held by a midwife before he had his first skin to skin contact with his Father instead of his Mother. Our first feed delayed and our early moments together foggy from anaesthetic, the odds were stacked against us, but my memory of our first touch is, perhaps miraculously, that of utter adoration. 

Oliver was the exact opposite of Alfie. He screamed with rage endlessly, and the only thing I knew to do to calm a crying baby was breastfeed him. But Oliver would not, or could not, breastfeed. How could I feel like a mother if he rejected my breast?! For me, Motherhood was tied up in my body nourishing my baby.  So I did the next best thing I knew and I expressed my milk for him. Endlessly. 9, even 10 times a day. I pumped, my husband washed the bottles and helped to feed Oliver. I mourned the loss of breastfeeding – something so powerful and unique to motherhood. I cried, I blamed myself, I felt that perhaps there was something wrong with my body all over again, after 3 years free from drowning in self hatred and disordered eating. But still I pumped. I carried Oliver everywhere in a sling, a desperate attempt to claw back the physical contact we missed. The physical contact that I knew would end his screaming if he would just stop fighting me long enough to accept my breast. 

The dust settled, I began to feel empowered through fighting the odds and exclusively pumping, I built an impressive stash of milk. I decided to train as a breastfeeding counsellor so I could support other women struggling like me. And, as I worked my way through the first of what would be 15 months of written work and practical assignments, Oliver latched to my breast and started to breastfeed. 

Oliver taught me patience, compassion, and non-judgement. Once more, in a world of bottles and pressure to formula feed I learned that breastfeeding is empowering, liquid love against the odds in our society. My breastfeeding journeys combined have changed me as a person, changed the way I see myself, and eased my transition into Motherhood. I qualified as a breastfeeding counsellor with the ABM this year, an achievement that stands out to me as a direct result of my experiences breastfeeding, and the support I received from other women, volunteering their time for free. Something I can now pay forward, and I am truly honored to have such a wonderful opportunity to walk alongside breastfeeding families,  be it for a 20 minute phone call, or ongoing support at group, or just through the peer support network of Booby friends I’m proud to call my own.