A couple weeks ago I did my training to become a Certified Lactation Counselor. I knew probably about 80% of it already (since I am a voracious reader of birth/breastfeeding blogs and academic studies on evidence-based practices, and I have worked with breastfeeding moms), but I also learned a lot, too.
Some of the new and awesome things that I learned in CLC training:
1. Babies can detect breast cancer (WTF): There is something called Goldsmith's sign, which is when a baby might be detecting undiagnosed breast cancer. The baby refuses to nurse on one breast. If other reasons such as ear infection, teething, birth trauma, etc are ruled out, breast cancer might be a possibility! And cancer may be diagnosed as late as 5 years after this sign from baby.
2. Breastfeeding provides protection for LIFE: When mothers who breastfed their baby donated a kidney to their adult child later in life, the adult child had less organ transplant rejection (compared to mother-child pairs that had not breastfed). The same protection was afforded when there was a sibling --> sibling organ or tissue transplant, if they had breastfed.
3. Powdered formula is not a sterile substance: It must be prepared at a temperature of at least 158 degrees F (and then cooled) before being fed to an infant, and you should not prepare a large amount ahead of time. A powder cannot be sterilized, and formula has been found to contain harmful microorganisms from time to time.
4. Colic = crying for more than 3 hours/day for more than 3 days/week, for greater than 3 weeks. I didn't know that definition!
5. Great resource! How to Safely Co-Sleep: The UNICEF UK Baby Friendly Initiative have a helpful pamphlet on how to safely sleep or co-bed with your baby. This is more than the U.S. provides, as they just say "don't do it," but people do it anyway, and do it unsafely.
Of course I learned a lot of other things, too, but less new and less awesome (and thus not worth sharing here). But in case you're interested in what the training covered...
On the first day we covered: International and national breastfeeding policy context, evidence-based practice, lactation credentials, examination of factors influencing success at breastfeeding, national perspectives on breastfeeding rates, anatomy and physiology of lactation, hormones of lactation, composition of human milk, gastrointestinal hormones of lactation, distinct weight gain patterns of breastfed babies, and myths about milk supply.
On the second day we covered: The effect of substances and objects on milk supply, the effect on milk supply of hypoglycemia, jaundice, latch-on, engorgement, implants, effect of milk supply of discrepant breast size, breast surgery, inverted nipples and others, counseling women with fears about milk supply, approaches to use in patient education with different types of learners, health outcomes associated with infant feeding choice, safer use of infant formula, and donor milk banking.
On the third day we covered: Application of social psychology theory to lactation counseling, influencing the infant feeding decision, men's concerns about breastfeeding, enhanced effectiveness through lactation counseling skills, supporting the mother's desire to breastfeed exclusively, the impact of maternity care practices on breastfeeding outcomes, parameters of feeding assessment, and strategies that have been found to be effective in assessing breastfeeding.
On the fourth day we covered: Strategies for dealign with the challenge of breast problems, milk expression, milk storage and handling, supplemental feeding methods for the breastfed baby, working women and breastfeeding, strategies for building or maintaining a milk supply under challenging conditions, galactogogues, strategies found effective for assisting babies with special challenges, effect of breastfeeding on amenorrhea and fertility, the effect of foods in the mother's diet on the infant, the effect of alcohol, caffeine, and environmental contaminants on mother's milk, the impact of medications on the infant, and contraindications to breastfeeding.
On the fifth day we covered: Early support in the "zone of professional unavailability," common concerns after the early weeks - ages and stages, vitamin supplementation, complementary feeding, weaning, nursing older babies, nursing strikes, ethical issues in lactation care, and the Baby-Friendly Hospital Initiative
A lot of people in my course were new to working with breastfeeding moms - many people from the community, some people in public health, a few from Healthy Start-type positions, a handful of doulas, but only one nurse. I have realized this is not the normal audience for this type of class, which is generally mostly people from medical backgrounds. Elita at Blacktating writes about her course, which had a different audience, but was structured similarly to mine.
The organization that runs the course, The Center for Breastfeeding, has claimed that the CLC certification is equal to the IBCLC training in that both are "entry level." You can read more about their opinion here: Position Paper on the Comparative Roles and Training of the IBCLC and CLC. Basically they believe that since the CLC course has not only an exam that must be passed, but also several competencies, that it is just as good a training as the IBCLC, where "anyone can take the exam" and there are no competencies. I beg to differ. The IBCLC certification requires over 1000 clinical hours, in addition to certain pre-requisite education on anatomy/physiology, etc, and the CLC training does not require any. I imagine this is all part of a political rivalry between the two certifying organizations.
I'm glad to have added this training to my skill set, and anxiously await the results of my exam!
Monday, May 21, 2012
Sunday, May 13, 2012
Breastfeeding in the News
So, I'm a little late in writing about some of these stories, but I did want to post about them.
1. Beyonce breastfed! And she "endorses" it! This is a great thing for black breastfeeding moms everywhere - a great role model. She says
It does seem odd that the message she (or her representatives) wanted to send was that it helped her lose a lot of weight. She could have been such a great breastfeeding cheerleader!
2. New York City Mayor Bloomberg is bringing the Baby Friendly Hospital Initiative to NYC hospitals, and for some reason this has perpetrated a lot of misunderstanding and disapproval of the initiative. Many people think that it means that hospitals are going to force moms to breastfeed:
THAT IS NOT WHAT THE BFHI DOES.
Unfortunately, Whoopi Goldberg led a heated attack on the initiative on The View. She told Mayor Bloomgberg "This is not your place. Back Off" and said that "Not all women can breastfeed."
I think it is really a shame that we have a good black breastfeeding role model situation followed by terrible black breastfeeding role model. Build it up, Break it down.
Here are 10 reminders about the 10 Steps to a Baby-Friendly Hospital, inspired by Whoopi Goldberg:
1. Beyonce breastfed! And she "endorses" it! This is a great thing for black breastfeeding moms everywhere - a great role model. She says
"I lost most of my weight from breastfeeding and I encourage women to do it; It's just so good for the baby and good for yourself."Unfortunately, she only breastfed for 10 weeks, but that's still GREAT. We won't know what contributed to her decision to stop, but every mom has the right to make that choice. Any breastfeeding is better than no breastfeeding!
It does seem odd that the message she (or her representatives) wanted to send was that it helped her lose a lot of weight. She could have been such a great breastfeeding cheerleader!
2. New York City Mayor Bloomberg is bringing the Baby Friendly Hospital Initiative to NYC hospitals, and for some reason this has perpetrated a lot of misunderstanding and disapproval of the initiative. Many people think that it means that hospitals are going to force moms to breastfeed:
THAT IS NOT WHAT THE BFHI DOES.
Unfortunately, Whoopi Goldberg led a heated attack on the initiative on The View. She told Mayor Bloomgberg "This is not your place. Back Off" and said that "Not all women can breastfeed."
I think it is really a shame that we have a good black breastfeeding role model situation followed by terrible black breastfeeding role model. Build it up, Break it down.
Here are 10 reminders about the 10 Steps to a Baby-Friendly Hospital, inspired by Whoopi Goldberg:
- Baby-Friendly represents a set of maternity practices that improves breastfeeding outcomes.
- Baby-Friendly is NOT about coercing women to breastfeed.
- Baby-Friendly is about assuring women have the information they need to make an informed feeding choice.
- According to the Surgeon General, 75 percent of women start out breastfeeding. Baby-Friendly is about helping these women realize SUCCESS in their breastfeeding goals.
- The benefits of Baby-Friendly practices extend to bottle feeding families too. For example, all babies benefit from skin-to-skin contact with their parents.
- Baby-Friendly is also a call to action to improve the safety of formula feeding through enhanced education to families who choose to bottle feed.
- Baby-Friendly hospitals provide formula for families who choose to use it while in the hospital. However, a physician order is required before supplementing a breastfeeding baby’s feedings with formula.
- Successful breastfeeding is a public health issue. The benefits extend to both mothers and their babies, and breastfeeding is recommended by the American Academy of Pediatrics as a way to help prevent Sudden Infant Death Syndrome (SIDS).
- With our growing understanding of brain health, neuroplasticity and how the brain is “wired” from an earlier age than we ever before realized, we may even conclude that parent-infant bonding is a public health issue as well as a significant social issue. Feeding choice aside, Baby-Friendly practices facilitate bonding.
- Mayor Bloomberg is not alone in promoting the Baby-Friendly Hospital Initiative. He is joined by the Surgeon General, The Joint Commission, the American Academy of Pediatrics, the Association of Women’s Health, Obstetric and Neonatal Nurses, the American Congress of Obstetricians and Gynecologists, the CEOs of approximately 500 U.S. hospitals and nearly 20,000 hospitals worldwide.
3. This divisive TIME magazine headline is just meant to fuel the Mommy Wars... Just in time for Mother's Day. I had a problem with the headline, which pits moms against each other, but apparently most people took issue with the "hot" mom breastfeeding her 3-year-old son. They are calling it "sick" and "perversive."
I posted a ton about this on my facebook page, but in case you weren't able to keep up with all that...
- TIME wanted attention. They have gotten that. via the Huffington Post piece "No I am not Mom Enough": "Breastfeeding is not a macho test of motherhood, with the winner being the one who nurses the longest. In fact there ARE no macho tests of motherhood. Motherhood is -- should be -- a village, where we explore each other's choices, learn from them, respect them, and then go off and make our own."
- Anthropologist Katherine Dettwyler weighs-in on extended breastfeeding and the TIME cover at USAToday "Breast-feeding a 3-year-old is normal, anthropologist says": "Dettwyler, who has published studies on breast-feeding, found that most children around the world are breast-fed for three to five years or longer."
- The Academy of Breastfeeding Medicine writes a great piece "TIME cover sells out moms to sell magazines":"The cover not only castigates mothers and children who practice extended nursing, but it also lends legitimacy to strangers who assail moms for nursing any infant in public as “nasty” and “indecent.” Recent stories of nursing mothers ejected from big box stores, courtrooms and churches demonstrate that it is not easy to be a breastfeeding mother in America. When you follow medical recommendations, you face public humiliation."
- A dad/comedian writes a piece called "From Breasts to Boobs and Back Again": "Let’s remember that the child is 3. Don’t forget how litte 3 year olds are. It’s why the photographer had him stand on a chair. Otherwise, he’d be sucking his mother’s knee"
- Celebrities Who Breastfed Toddlers, but not on the Cover of Time: "Because breastfeeding past one year is often hidden from view, it might appear that children such as the one on the Time cover just don’t exist . . . but they do. Best for Babes collects and shares celebrity stories to increase the cultural acceptance of breastfeeding. The celebrity stories below show that this “uncommon” act of nursing a toddler might be more common than you think."
- On Breastfeeding past infancy by an evolutionary Anthropologist: "Extended breastfeeding is the norm in most human and primate societies. So why are we the weird ones?"
Many, many moms who enjoy breastfeeding breastfeed their children past infancy, they just may not tell anyone about it. But they are following the American Academy of Pediatrics and the World Health Organization recommendations, which recommend breastfeeding up to a year and beyond, as desired.
This post at Motherwear Breastfeeding Blog explains some of the misconceptions about extended breastfeeding!
Wednesday, May 2, 2012
The Learning Never Stops
Happy May! I meant to post more than I did in April, but the end of my semester completely overwhelmed all my time! The good news is that I've been doing a lot of doula prenatal visits for my clients who are due this month and next month. Prenatal visits are so great! I love talking birth. This is why I should really become a childbirth educator, so I can just talk birth all the time.
In one of my recent prenatal visits my client taught me a few new things. First, she pointed out that the longer she is pregnant, the more her fundal height matches her gestation length! Fundal height is measured from the top of the pubic bone to the top of the fundus which is the top part of your uterus (the highest part of your baby bump, under the breasts) Fundal height is measured in cm, gestation length in weeks. So, for example, when she was 25 wks 5 days, her fundal height was 26 cm, and when she was 30 weeks, her fundal height was 30 cm! I had no idea that this occurred, but it is so cool. Unfortunately, it's not an exact science, but it does give a good indication of fetal growth. If for some reason the measurement was not as expected, an ultrasound may be useful!
The second thing, which I have been exploring a bit more on my own, is that she wants to drink at least a pint of very strongly brewed red raspberry leaf tea once she is in labor. It is known that raspberry tea has an effect on the uterus, by relaxing the smooth muscles while it is contracting, and many women drink it late in pregnancy to "prepare" their uterus for labor by toning and strengthening it. Anecdotally, women have said that it can ease labor or even make it shorter. This is why my client wants to try it. She has heard that just drinking it leading up to labor is not enough; some women have noted that when they downed a large amount of it in early labor that their labors were shorter. Since there have been no noted side effects for the woman or the baby with raspberry leaf tea late in pregnancy, we all agreed she can go ahead and try it if she likes! So, I will let you know how that goes ;) When I asked some doulas on twitter what they thought about this, many different responses came up. Some said red raspberry leaf tea is good to get contractions going, some said it can slow them out and make them more regular, that it strengthens contractions, and that she shouldn't be disappointed if it doesn't work exactly as she was hoping. What do you think? Do you have any experience with raspberry tea for labor? Would you try this method?
Additional good news is that next week I'll be doing the Certified Lactation Counselor (CLC) training. Has anyone taken that before? I am wondering what CLC's go on to do after they become certified. In addition to working with a local non-profit that supports breastfeeding, or just adding it to my doula services repertoire, what else can I do with my CLC? Do CLC's do independent work that they charge for? Do you run peer support groups, La Leche League style?
Tuesday, April 17, 2012
Personal Update
A lot of this blog is about sharing information that I find that's new or interesting, and not as much about personal doula updates anymore. I used to do a lot more back at the beginning of the blog when I was just starting out. I even posted some or my doula birth stories! But when I got some flack about sharing too much personal information, I sort of stopped.
Also, as I'm in grad school, I don't take on a lot of clients. My semesters have really been ramping up the longer I am in this program, and I just haven't felt like I could handle being on-call. As a result, I don't want to come on here all the time and write about my meetings or births or impressions just in case my professional identity can be linked to this blog, and my clients get upset about something I say on here. Also, because I don't take on a lot of clients, there's less to share in general!
But since I haven't done a personal doula life update (or a "doula journey" post) in a while, I thought I'd take the time to write one down.
I've recently taken on some fabulous clients that are due this summer. One client interviewed and hired me at only 10 weeks gestation! So it has been an interesting experience having a client that long. I worried about the potential for having to go through a miscarriage with her (which thankfully didn't occur), and also about how to keep the relationship over such a long time (I'm used to the meetings all occurring in the last trimester of pregnancy - sometimes even the last month only!). So far it has worked out. I went on a hospital tour with them, so it was great to see them and chat then. She has kept up with e-mailing me with photos of her baby bump, the baby's sex, and lots of questions, so that's been great, too! They also invited me to a baby shower, and we will soon start our prenatal appointments together.
Two additional clients are both due in the same month, so I am glad to have some back up support from my wonderful back-up doula. With the first, the husband seems very concerned that he will have a highly active role to play, that I will just be there to give him reminders of what to do. Until I spelled that out multiple times in several different ways, I didn't see his smile. Dads are always all-business, while moms do most of the talking. My other client is of an older age, and I always find that the older moms who are pregnant for the first time do a LOT of talking. She tells me everything! I think it is really great. She is also delivering at a birth center that I haven't been to, yet, so I'm excited to meet the midwives there and have that experience.
Recently my doula friend who is still certifying asked me if she could shadow me on one of my births. She has already asked the permission of my client and gotten it. I have never had a doula shadow me, and I'm not sure how that will go! I almost don't feel like I'm seasoned enough to provide guidance for a doula-in-training, and I'm wondering how it will change the way I doula. Can anyone give any advice on this?
Once my semester ends I'll be taking a 5-day Certified Lactation Counselor (CLC) training. I'm very excited for this, as I've wanted to add additional breastfeeding training to my skill set, and also because I'm hoping it will provide hours for my birth doula re certification requirements with DONA. If you're a DONA doula and you'd like more info on re certification requirements, they recently made a webinar on this topic! Additionally, serving as a preceptor at a birth with a doula-in-training counts as an alternative method to obtain continuing education contact hours!
In other news, I am officially Certified in Public Health, now that I've found out that I passed my CPH Exam!
Also, as I'm in grad school, I don't take on a lot of clients. My semesters have really been ramping up the longer I am in this program, and I just haven't felt like I could handle being on-call. As a result, I don't want to come on here all the time and write about my meetings or births or impressions just in case my professional identity can be linked to this blog, and my clients get upset about something I say on here. Also, because I don't take on a lot of clients, there's less to share in general!
But since I haven't done a personal doula life update (or a "doula journey" post) in a while, I thought I'd take the time to write one down.
I've recently taken on some fabulous clients that are due this summer. One client interviewed and hired me at only 10 weeks gestation! So it has been an interesting experience having a client that long. I worried about the potential for having to go through a miscarriage with her (which thankfully didn't occur), and also about how to keep the relationship over such a long time (I'm used to the meetings all occurring in the last trimester of pregnancy - sometimes even the last month only!). So far it has worked out. I went on a hospital tour with them, so it was great to see them and chat then. She has kept up with e-mailing me with photos of her baby bump, the baby's sex, and lots of questions, so that's been great, too! They also invited me to a baby shower, and we will soon start our prenatal appointments together.
Two additional clients are both due in the same month, so I am glad to have some back up support from my wonderful back-up doula. With the first, the husband seems very concerned that he will have a highly active role to play, that I will just be there to give him reminders of what to do. Until I spelled that out multiple times in several different ways, I didn't see his smile. Dads are always all-business, while moms do most of the talking. My other client is of an older age, and I always find that the older moms who are pregnant for the first time do a LOT of talking. She tells me everything! I think it is really great. She is also delivering at a birth center that I haven't been to, yet, so I'm excited to meet the midwives there and have that experience.
Recently my doula friend who is still certifying asked me if she could shadow me on one of my births. She has already asked the permission of my client and gotten it. I have never had a doula shadow me, and I'm not sure how that will go! I almost don't feel like I'm seasoned enough to provide guidance for a doula-in-training, and I'm wondering how it will change the way I doula. Can anyone give any advice on this?
Once my semester ends I'll be taking a 5-day Certified Lactation Counselor (CLC) training. I'm very excited for this, as I've wanted to add additional breastfeeding training to my skill set, and also because I'm hoping it will provide hours for my birth doula re certification requirements with DONA. If you're a DONA doula and you'd like more info on re certification requirements, they recently made a webinar on this topic! Additionally, serving as a preceptor at a birth with a doula-in-training counts as an alternative method to obtain continuing education contact hours!
In other news, I am officially Certified in Public Health, now that I've found out that I passed my CPH Exam!
Saturday, April 14, 2012
The Baby-Friendly Rap
A Tale of Two Births: The Baby-Friendly Rap
Um, I definitely love that the breastfeeding success all depends on the presence of the Super Doula!
Want to know more about what this "Baby Friendly" hospital means? Here's more info on the Baby Friendly Hospital Initiative
See birth at a Baby-Friendly Hospital versus a Typical Hospital.
Cosponsored by the Breastfeeding Coalition of Oregon and the Massachusetts Breastfeeding Coalition.
Cosponsored by the Breastfeeding Coalition of Oregon and the Massachusetts Breastfeeding Coalition.
Um, I definitely love that the breastfeeding success all depends on the presence of the Super Doula!
Want to know more about what this "Baby Friendly" hospital means? Here's more info on the Baby Friendly Hospital Initiative
Saturday, April 7, 2012
Cesarean Awareness Month
April is Cesarean Awareness Month!
Sponsored by the International Cesarean Awareness Network (ICAN). Check our their suggested advocacy recommendations:
Check out this Public Service Announcement for more info on Cesareans and Vaginal Birth After Cesarean:
Also, raise awareness of what is happening with C-sections in the U.S. by sharing these publically available hospital cesarean rates.
How to Avoid a Cesarean Section
Sponsored by the International Cesarean Awareness Network (ICAN). Check our their suggested advocacy recommendations:
Be an Advocate for Women
- Search ICAN’s Hospital VBAC Policy Database to find out if your local hospital bans VBACs or not.
- Does your local hospital have a VBAC ban in place? Please contact ICAN with a short description of your situation and any specifics about the situation.
- Write your elected officials. We provide template letters for your use and links for you to easily contact your specific legislators, as well as recommendations for who to write about Health issues.
- Ready to start reversing VBAC bans? Read 50 Ways to Protest a VBAC Denial and contact Barbara Stratton, ICAN’s VBAC Ban Chair.
- Unhappy with how you were treated while in the hospital? You might think you have no options but you do. Read ICAN’s primer on how to file complaints about your maternity care.
- Have you lost or been refused medical insurance because of a previous cesarean? Please contact your state insurance commissioner to file a complaint and if you are willing to speak to the media, contact the ICAN Advocacy Director.
Check out this Public Service Announcement for more info on Cesareans and Vaginal Birth After Cesarean:
Also, raise awareness of what is happening with C-sections in the U.S. by sharing these publically available hospital cesarean rates.
How to Avoid a Cesarean Section
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