June Myers, IBCLC
Breastfeeding in our modern context is a personal choice. But what is not well promoted is that it is a biological extension of pregnancy and birthing that requires just as much or more support for those who choose to breastfeed. This support is vital, not just in the hospital, but well beyond the hospital stay. Understanding continuity of care from hospital International Board Certified Lactation Consultant (IBCLC) staff to outpatient and private practice in-home visits with an IBCLC is important for achieving individual goals, especially in the presence of challenges. I (June Myers, IBCLC), am currently serving across the continuum of care in a hospital setting and in the private practice home health setting with my own practice, Mom to Mom Lactation Services, and as a contractor with Nurture Columbus.
Continuity of Care
Some new parents may feel like the lactation support in the hospital is enough or all that can be provided. It is important to know though that breastfeeding is a process and typically takes longer than 48 hours to learn! All hospitals should therefore be providing families with a thorough list of resources and ideally referral upon discharge to lactation consultant care in the community to ensure what is initiated in the hospital is sustained at home, and consistent with patient goals and public health recommendations.
Hospital IBCLC Work
Lactation consultants in the hospital strive to share as much knowledge as possible within a very limited time frame and about a subject with many varying branches of need. These include help with latch, instruction on whether baby is thriving with sufficient milk intake, education on pumping, ordering breast pumps, setting up breast pumps and providing further education on use and cleaning. Most lactation consultants in the hospital try to visit new parents multiple times to assist, inform on what is biologically normal, look for signs of oral restriction, promote understanding of newborn behavior, teach skills to relieve breast engorgement, address pain, prevent pain, troubleshoot what might happen in the future and much more. They encourage families emotionally, instill confidence in lactation and all within the framework of the hospital setting and rules. In eight hours, an IBCLC may see up to a dozen or more patients. And then document, report concerns to staff, and assist in educating nurses and physicians.
Hospital Patient Experience
Patients during a hospital stay also have limitations. There is an endless march of people in and out of their room. These can include family, friends, hospital staff, meal delivery and clergy to name a few. At times, there is barely a chance to rest or shower. Mothers may have had a difficult labor or c-section, adding challenge to processing information shared about breastfeeding. One new mother I recently spoke with stated “I just didn’t know what I didn’t know.” Until there is time to rest and reflect on this new role of feeding little ones, there may not be awareness of what questions to ask or what information and support is necessary. On top of all of this, most parents are heading home in 24-48 hours, milk supply has yet to increase. Overall, it can be a very challenging time. Continuity of care once home can be imperative to achieving intended breastfeeding goals.
Shifting to In-Home IBCLC Care
Generally speaking, rest is a bit easier to come by at home. There is more clarity about what concerns apply to each unique situation. Common concerns include breast engorgement, infant intake, optimal positioning, nipple soreness, recognizing newborn cues and establishing/sustaining milk supply to name a few.
Most in home lactation consultants have a quality scale and will do a pre- and post-feed weight check. This will reassure intake is sufficient for growth and supply, or indicate need for supplementation with expressed milk, donor milk or formula. An in-home IBCLC will spend an hour and a half to two hours listening to concerns, ascertaining goals, discussing questions and troubleshooting an array of situations. A clear care plan is provided to progress toward goals. Ideally, follow-up is scheduled until a parent feels confident with breastfeeding. Health plan coverage helps with this and is something we offer with many plans.
Learning is best accomplished when comfortable and familiar with surroundings, especially during any life transition like having just birthed a baby! Breastfeeding is a new experience for most of my clients. Trusting a process never experienced before can be difficult. Many mothers I see though say that it is helpful to learn how to position and latch in the comfort of their home with a more relaxed frame of mind and where feeding normally happens.
The Take Home Message
Things are more likely to come together quickly when working with an experienced IBCLC who can understand specific needs and support goals but continuity is key. Hospital staff are doing their best but are limited with time. While breastfeeding can be initiated in the hospital, it has many phases and typically cannot be fully learned in 24-48 hours. There is a continuum of care and knowledge to be aware of as well across the healthcare system and among providers within it. Not everyone knows as much about breastfeeding as you might imagine. If you’re having challenges, reach out early and often to a lactation consultant with time and knowledge to help. Lactation troubles can have a domino effect. The more time that passes the more likely issues will multiply. Scheduling within a few days of being home from the hospital is best. The sooner you get help the sooner you can be relaxing in the comfort of your home while feeding your sweet baby!
About the Author:
June Myers, IBCLC, has had years of experience supporting families at WIC, in hospital settings, as an Ohio Department of Health Breastfeeding Hotline operator and in private practice. She prides herself on building rapport, explaining breastfeeding in easy-to-understand ways and following up with clients through in home consultations.