By Christine Staricka, IBCLC
I’d like to open a window for you to see what I experience during the 24-72 hours after birth as a hospital-based IBCLC in the United States. It may or may not surprise you, but it will definitely broaden your perspective.
A typical day for me and my colleagues begins with accessing a current census report of mothers in the postpartum unit, the NICU, and the pediatrics unit. Prioritizing patients is one of the most difficult tasks I face. The reason is simple: every nurse correctly believes that her patient is the most important and needs to be seen immediately. In many cases, when I tell a nurse that her patient will be seen later rather than sooner, I listen to her case assessment and help her by making specific suggestions on how to help get through the next feeding or two. Every day, I teach as many nurses as I do moms, reinforcing both clinical and assessment skills and reframing perspective in terms of infant health outcomes.
Collecting information on dyads is a time-consuming task. I consult the charts; check the white board on which nurses write feeding status and significant outcomes for each dyad; talk to nurses and pediatricians; and most importantly, I talk to the mother while I observe her baby at her breast.
Often a postpartum mom is medicated, stressed from a difficult or long birth, and overwhelmed by the sheer number of hospital employees knocking on her door for various reasons. Talking to the new mother is an exercise in proper communication skills to overcome her reluctance to let another stranger into her world and to build credibility and a sense that I am there to advocate for her and her baby.
I ask for her opinion on breastfeeding progress, mentally comparing it with information I have already gathered. Often she expresses a vastly different picture. She may feel it’s going terrible because the baby wanted to nurse all night and is clearly not getting enough milk, while the nurse has assessed the latch and notes that baby has had 5 stools and 2 wet diapers in the first 24 hours. Or the mom may say it’s going fine even though it hurts a lot, and she knows that’s normal because all her friends told her that breastfeeding is supposed to hurt; however, the baby lost more than 7% of birth weight in 36 hours and has a high bilirubin level for his age. Sometimes the answer is obvious but most times, it takes more detective work: “Tell me about your birth…”
The more you talk, the more opportunity is created to educate, correct myths, and address misperceptions. In the hospital, many times the moms I see are not yet aware they need help. She may not even truly want help. That puts an extra burden on me to discern how much I can assist, and I’ve learned through experience to sense from her responses when it is advisable for me to ask explicitly whether she would like me to work with her, what were her original feeding goals, and how she would like to proceed while still in hospital.
During my hours on the floor, I wear a pager so that patients and staff can find me in the building. We maintain a lactation helpline where any mom in the community can leave a voicemail if she needs breastfeeding support and I also see moms on an outpatient basis as needed after they have been discharged home.
I do a LOT of paperwork. I am required to document every contact with a mother, short or long, phone or in-person, and also some with nurses where I give specific instructions on how to help. I am required to document those contacts on my own daily activity log, as well as documenting them in legally-approved patient charting methods, all of which are handwritten in our facility and are subject to subpoena by the courts in case of litigation. When I have contact with the mother of a baby in NICU, I document in the baby’s chart, plus I also make notes on the contact on an individual dyad tracking sheet to assist with continuity of care among lactation consultants because the physical charts for those babies are not easily accessible to us. I sign in multiple places in patients’ charts that I have provided required education on those topics, and I collect feeding statistics from mothers for hospital reporting requirements. I compile multiple types of breastfeeding statistics for various purposes within the hospital; sometimes those reports influence policy and procedural changes, a very rewarding direct outcome of my efforts.
I facilitate a monthly breastfeeding support group sponsored by the facility. I assist in formal staff education events held annually for each individual unit within the Maternal Child Health Department. Our lactation staff doubles as the Parent Education staff (and thus required to maintain current certification as Childbirth Educators) so we are responsible for teaching Childbirth Education Series, Prenatal Breastfeeding Classes, and hosting weekly maternity Orientation Tours of the facility for pregnant women and their partners, in addition to teaching a daily Discharge Class for patients discharging home that day. We create handouts for parents which meet Baby Friendly standards and IBCLC Standards of Care. I am sometimes called upon to assist hospital employees who themselves are facing breastfeeding and/or pumping challenges as they return to work and advocate for them as needed. I collaborate with the local Women, Infants, and Children (WIC) services to ensure individual mothers in need get breastpumps and basic breastfeeding support as needed.
I often wish I was able receive feedback and validation which comes from building a relationship with my patients. Almost everyone I see disappears into the ether and I never know if I affected them. Fortunately, there are those beautiful few who call with questions, who come back in for more help, who send lovely thank-you cards, who attend support group, and whose babies I am privileged to see as they grow up. I feel comfortable speaking for all my hospital-based IBCLC peers in saying that the rewards we reap from just a tiny few of those we meet in our demanding professional setting are enough to make us happy to see the multitudes every day.
Christine Staricka became a Certified Lactation Educator through UCSD while facilitating local breastfeeding support groups. She studied independently while accumulating supervised clinical hours and passed the exam in 2009 to become an IBCLC. She holds a BA in Business Management from University of Phoenix. She has contributed to USLCA’s eNews and she moderates a community-based breastfeeding information and discussion page on Facebook at Facebook called BakersfieldBreastfeeds. She enjoys tweeting breastfeeding information as IBCLCinCA and maintains a blog by the same name. She is a wife and mother of 3 lovely and intelligent daughters and aunt to 4 nephews and 2 nieces, all of whom have been or still are breastfeeding. She is partial to alternative rock and grunge music, especially Pearl Jam, and attends as many concerts as financially possible with her husband of 18 years.