Bianca Balogh
Breastfeeding is a cornerstone of early infant nutrition, providing invaluable health benefits for both mother and baby. However, the journey isn’t always smooth sailing. Challenges can arise, and that’s where International Board Certified Lactation Consultants (IBCLCs) step in to provide expert guidance and support. As educators, nurses, lactation specialists, doulas, midwives, and other birth workers, understanding when, why, and who should refer to an IBCLC is essential in ensuring optimal care for breastfeeding families.
When to Refer to an IBCLC
Early Postpartum Challenges
The early postpartum period is a critical time for the establishment of breastfeeding for both the new mother and her newborn baby. Refer to an IBCLC when mothers encounter difficulties, such as latching issues, nipple pain, engorgement, or a delay in lactogenesis II (the increase of abundant milk supply). It’s also appropriate to direct patients or clients to an IBCLC when the baby is born early, has excessive weight loss, slow weight gain or if the baby requires supplementation. Early intervention can prevent issues from escalating and support a positive breastfeeding experience from the start. Any delay in addressing breastfeeding issues could predispose the breastfeeding dyad to feeding complications that are difficult to reverse, such as low milk supply and bottle preference.
Persistent or Complex Issues
If breastfeeding challenges persist beyond the first few weeks postpartum, it’s essential to involve an IBCLC. Persistent problems like poor weight gain, recurrent mastitis, or unresolved latch issues may indicate underlying issues that require specialized support. Sometimes a deeper problem exists that is illustrated in another way. For example, a baby could have an oral restriction (“tongue-tie”) which causes signs and symptoms of a painful latch, clicking sounds during feedings, and slow weight gain. IBCLCs have the expertise to assess and address these challenges effectively, providing tailored solutions for each family’s unique situation.
Special Circumstances
Certain situations necessitate immediate referral to an IBCLC. These include premature birth, multiples, infants with special needs, or mothers with medical conditions affecting breastfeeding. IBCLCs can offer specialized support and strategies to meet the unique needs of these families, ensuring optimal breastfeeding outcomes despite challenging circumstances.
Why Refer to an IBCLC
Expertise and Training
IBCLCs undergo rigorous training and certification through the IBCLC Commission, including education, clinical practice, and a commitment to codes of conduct, equipping them with in-depth knowledge of lactation physiology, infant feeding behaviors, and common breastfeeding challenges. Recertification is required every 5 years. Their expertise enables them to provide evidence-based guidance and support tailored to each mother and baby’s unique needs, ensuring comprehensive care from a trusted professional.
Individualized Care
No two breastfeeding journeys are alike, and IBCLCs recognize the importance of personalized care. They consider factors such as maternal and infant health, breastfeeding history, and family dynamics to develop customized care plans that support breastfeeding success. By collaborating with families, IBCLCs empower parents to navigate breastfeeding challenges with confidence and resilience.
Clinical Assessment and Intervention
IBCLCs are skilled in conducting thorough assessments of breastfeeding issues. They provide hands-on support with positioning and latch, offer guidance on milk production and management, and address concerns such as tethered oral tissue or nipple trauma. Their clinical expertise ensures that families receive the highest standard of care for breastfeeding challenges. Some lactation consultants can visit families in their homes for an in-depth appointment to view and assess a mother’s breastfeeding session, environment, and feeding plan. Others will offer continuation of care where the breastfeeding family comes to a hospital or office location.
Who Should Refer to an IBCLC
| Educators | Educators play a crucial role in preparing expectant parents for breastfeeding. While they provide valuable information and support, educators should refer families to an IBCLC if breastfeeding challenges arise that require clinical assessment and intervention. Many times, educators are one of the first professionals to begin talking about birth and breastfeeding with expectant parents in prenatal classes. Talking about working with an IBCLC if challenges arise can set up realistic expectations early on. Discussing that creating a comprehensive feeding plan if breastfeeding isn’t going quite as expected creates a safety net that will ensure families reach their breastfeeding goals with the comprehensive care many situations require. Giving referrals during class to local IBCLCs or hospital programs can help parents prepare ahead of time instead of searching for help when they may be feeling frazzled after birth. |
| Nurses | Nurses are often the frontline caregivers for new mothers in healthcare settings. While they offer initial breastfeeding support, they should involve an IBCLC if mothers experience ongoing difficulties or concerns. Certain situations can arise immediately after birth that warrant collaborative care. Incorporating an IBCLC’s help is suggested if immediate problems arise, such as a baby with a cleft lip or palate, mother and baby are separated after birth, postpartum hemorrhage, or other concerns. IBCLCs can provide expert guidance and intervention to address breastfeeding issues effectively, promoting positive outcomes for mothers and babies. |
| Lactation Specialists | Lactation specialists, including Certified Lactation Counselors (CLCs) and Certified Lactation Educators (CLEs), offer valuable breastfeeding support and education. However, when faced with complex or persistent breastfeeding challenges, lactation specialists should collaborate with or refer to an IBCLC for specialized care. Working together, they can provide holistic support to breastfeeding families. |
| Doulas and Midwives | Doulas and midwives provide continuous support to mothers during pregnancy, birth, and the postpartum period. While they offer emotional and practical support, they should involve an IBCLC if breastfeeding difficulties arise that require clinical expertise and if they do not also hold that certification. Prenatal appointments will give midwives early access to a mother’s history. This information could alert the care provider to an important component that may impact the dyad’s breastfeeding journey. When a mother is referred to an IBCLC early on, she will be better empowered to achieve her breastfeeding goals. |
| Other Birth Workers | Various birth workers, including home visiting specialists, perinatal chiropractors, dietitians, massage therapists and other perinatal support professionals, may encounter breastfeeding challenges in their work with new families. While they provide valuable support and resources, they should refer families to an IBCLC if specialized care is needed. Collaborating with IBCLCs ensures that families receive comprehensive lactation support tailored to their needs. |
Closing Thoughts
Recognizing when, why, and who should refer to an IBCLC is essential for birth workers involved in supporting breastfeeding families. By leveraging the expertise of IBCLCs and fostering a collaborative approach to breastfeeding support, birth workers can help mothers overcome breastfeeding challenges and achieve their feeding goals, ultimately promoting the health and well-being of both mother and baby.
