Response:Guardian Letter to a Lactation Consultant

On Saturday The Guardian printed an anonymous “parent piece” from a mother who has a bad experience with a “lactation consultant” and her tongue tied baby.

Many aren’t aware that “Lactation consultant” is neither a recognised nor protected title. Your sister’s, friend Margaret who breastfed for half a day can call herself one.

Similarly, there isn’t an NHS job titled “lactation consultant” either (unlike I believe in the US) - so who this person was or what their qualifications are is incredibly unclear.

International Board Certified Lactation Consultant (IBCLC) is a certified title (although not registered and so ultimately poorly protected) , yet 90% of the time when someone says “lactation consultant”, the person doesn’t hold this certified title.

Unlike in the US, many hospitals in the UK don’t employ a certified IBCLC, even under a different title - although some do.Parents therefore often refer to anyone who helps them breastfeed as the lactation consultant.

As an IBCLC I cringed at the claims of what someone supposedly said, or perhaps implied.

So this certified lactation consultant is going to add another perspective:

1. No mum should be spending 12 hours a day feeding their baby. If someone feels overwhelmed, it’s important that the wants and needs of the parents are central to any “plan” established. I have seen plans set by some hospital staff with little breastfeeding experience, that have no gap for sleeping or eating. Instead two hourly feeding and pumping around the clock may be suggested, which is of course completely unsustainable.
2. Some mums want to use a hospital grade pump, other don’t. Some want to try a nipple shield, some don’t.
3. I’m unsure why a lactation consultant would ask a mum if she’s “fixed the tongue tie”, since this isn’t something a parent can do at home? If baby had a tongue tie diagnosed, when and by whom? Why is this "lactation consultant" not aware of if/when this is happening? It's all very confusing.
4. Frenugreek is a herb typically taken for low milk supply, which can follow a shallow latch associated with tongue tie. I’m not a huge fan personally, but some swear by it.
5. I’m not sure what poor garlic did wrong - a large study found that when breastfeeding mothers consumed garlic, their infants stayed at the breast and breastfed longer (1). And since an increase in breastfeeding can lead to an increase in the breast milk supply, this may be one of the reasons garlic can help breastfeeding mums make more breast milk.Which any certified IBCLC would likely know...

So what appears to have happened here is mum has been discharged attempting to breastfeed a tongue tied baby, with the first mention of support being after a problem has arisen.

The shallow latch meant baby couldn’t pull a full feed, despite feeding at the breast and so was still hungry afterwards. To try and provide more milk for the still hungry baby, mum has expressed - yet many are not given appropriate guidance on how to drain their breasts effectively with a pump. This means mums can invest significant chunks of time, for little milk removal. Some mums struggle to express well even if they have oodles of milk - triggering the milk ejection reflex is a learnt art and even then, some mums don’t respond to a pump the way they do a baby.

As a result of the reduced milk removal though, mum’s supply may reduce further despite her dedication - rather like pushing a boulder up a hill. This can quickly become understandably overwhelming.

The next section again leads me to question whether this was a certified IBCLC:

“more lactation cookies, more mother’s milk tea, more essential oils, more water, more calories, more nutritious calories, more hand expression, more, more, more.”

Lactation cookies and tea aren’t on the whole evidence based, and certainly not routinely recommended in the UK (much more popular in the US) - they tend to have more popularity on parent to parent social media pages.

Essential oils aren’t within the remit of an IBCLC and so would never be suggested in the UK (unless presumably the practitioner is also a certified and insured aromatherapist). Any parent needs to drink normal amounts of water and consume normal calories - drinking and eating excessive amounts doesn’t link to milk supply, so again this is a rather bizarre statement from someone who has supposedly undertaken rigorous training.

There are good and bad in any profession, I saw an appalling GP for an emergency appointment for a relative recently - not that I’m sure the Guardian would be interested in that though.

What’s worse here, is we internationally certified lactation consultants get the flack for anyone and everyone who ever helps with breastfeeding! In the absence of knowing the title of the person that actually helped, lactation consultant is used.

I’m not sure whether this article originated in the UK as the guardian doesn’t specify - but I’m sure many parents can relate to unskilled support lacking appropriate counselling skills they often find themselves left with.

I won’t hold my breath for a guardian article that follows from a mother with a polar opposite experience, I suspect I’d be quickly turning blue.