A week in my lactation clinic: ‘Breastfeeding is hard but it gets much easier than formula-feeding ’

I’ve been working as a lactation consultant since 2007. I started off as a volunteer breastfeeding counsellor with Ciudiú in 1993 and decided that I would take the step to become an international board certified lactation consultant (IBCLC) and start providing home care and dealing with mums on a one-to-one basis.

I saw so many women coming to support groups who had just missed out on that very early care and might have had an easier experience if they had had a home visit early on.

My working week changes from week to week. The bulk of my work is visiting women in their homes, all over Cork city and county. Consultations usually last about two hours. I do follow-ups, where they usually come to me, and I also give private antenatal classes in people’s homes.

I get quite a lot of phonecalls at two minutes after 9am on Mondays, typically from a woman saying, “‘I absolutely can’t carry on with this any more. I had my baby last week. I just need help.”

Others will phone over the weekend and we organise when I will see them the following week. I ask some questions on the phone and judge from the answers whether I need to see the mother very urgently. I usually try to see whether there is any pattern at all, so I’m guaranteed that when I go and visit that the baby will feed, because obviously I need to see them feeding.

Solutions

There are lots of reasons mums would phone, but in the early days the two main reasons would be because of sore nipples and faltering growth; so the baby isn’t putting on enough weight. Sometimes you just need to make small tweaks and sometimes you need to change things completely.

Sore nipples can be caused by not knowing how to position the baby and not latching the baby on to the nipple correctly. In our culture really we’re used to watching people bottle feed and sometimes women position the babies as though they are going to be bottle-feeding them, which will put pressure on nipples and make them sore, so we really need to turn babies right into mummies – belly to belly – and getting that right can be a bit tricky.

Three or four weeks in, some women still have sore nipples and sometimes that is to do with the baby having tongue tie, or they could get thrush or mastitis.

My job is to create an individualised care plan for them around breastfeeding and to provide them with solutions to whatever might be going on. I think sometimes they go to public health nurses and doctors and get a sort of a generic answer to what might be going on, whereas I will sit down and I take a big, long history and will tailor the plan to what that particular mum and that particular baby might need for the next few days. Then we’ll talk again and we’ll alter it until we work out whatever the problem might be and how we can fix it.

Another problem with this bottle-feeding culture is people expecting that there’s a schedule, because quite often bottle-fed babies have schedules. Breastfed babies feed when they need to, which can lead to a schedule lasting for two days and then changing.

I have quite a high success rate. I usually see people as much as possible from Monday to Friday between 9am and 6pm, but I will do evening calls if I get an emergency call and weekend calls if I’m available.

Latest research

I do a lot of tutoring with Cuidiú. I tutor about one weekend a month, which involves training breastfeeding counsellors or antenatal educators.

We have to do a lot of follow-up education so I go to the Cuidiú conference and the Association of Lactation Consultants (ALCI) conference every year.

I sometimes go to the La Leche League conference and I usually try to make an international conference on breastfeeding once a year as well. It’s vital to keep up to date with the latest research.

The low rate of breastfeeding in Ireland is multifactorial. We adopted the formula practice way back in the late 1950s and early 1960s and it just became the normal way to feed babies and our breastfeeding rates really, really dropped.

There has been an increase in our breastfeeding rates almost every year for the last five to 10 years. More than 50 per cent of women now initiate breastfeeding in hospital. But by day three or four, when they are coming home from hospital, a lot of those women have stopped. We were at 30 per cent 10 or 12 years ago.

Breastfeeding is hard. It gets much easier than formula-feeding in the long run, but at the start breastfeeding is very hard. I do think because we have this generational problem where mothers, husbands and grandmothers were all formula fed . . . [people don’t actually know] the normal behaviours of breastfed babies so we need to have more education.

Squidgy newborns

I love my work. I think I’m very privileged to be able to work with so many mums and their babies and to be able to help them resolve some of their difficulties. The best part of the job is seeing squidgy newborns. They are very special to work with.

One of the hard things is when a mum makes a decision not to carry on breastfeeding. I’ve worked with a few who have made that decision because solving the problems seems insurmountable to them. They have to make the decision as to what works for them as a family.

For a lot of them the milk supply isn’t intact. That can happen for various reasons: because she thinks she has to feed to a schedule and hasn’t been feeding the baby enough; because the baby might have a tongue tie and isn’t able to get the milk out. That problem can go on for a few weeks and it throws the milk supply. They will have to use breast pumps and take a herbal remedy and work really hard at building up the milk supply, and at the same time feed their baby.

It can be just really hard work and for some of them it seems insurmountable. I don’t blame them.