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.
This is a fantastic, if exhausting, description of an IBCLC who is passionate about her work helping breastfeeding families and educating healthcare colleagues. Your patients and co-workers are fortunate for their contact with you,Christine!
Thank you for this inside look into your day. I am an RN in a NICU. I am sure your facility has a much larger population. Our facility delivers approx 900 births per year and NICU admissions are about 6-10%. I am also an IBCLC but that is not my formal role. I do as much as I can and am really pushing for inpatient and outpatient LC services.
As an L&D RN and also an IBCLC I totally understand and appreciate all the hard work and long hours you put into your days. There may be days where it seems to go unnoticed and then we seem to have those special moments that help us bridge the days to the next special moment. I too run a support group and I’m always listening to Moms talk about those who truly listened to them while they were in the hospital and they always have a special place for those people. Yes, it would be nice to get the recognition on a daily basis, unfortunately such is life in a medical facility. As a mother of 3 also, trust me when I say that those who truly make a difference in a new mom’s life with her newborn, whether it be her first or her third, are always held in the highest regard! Keep up the great work you do!
Thank you for sharing! I am considering one of the pathways to become an IBCLC and am encouraged to read that you found such an amazing job without a nursing degree (I don’t have one either). Your description of your day-to-day responsibilities and patient interaction sounds like such an amazing job. Thank you again!
It is so nice to read this. It makes me feels less alone and more understood. Although we have electronic records which present its own set of chanllenges but I would not go back to paper.
While I feel that this is my calling and I have the job God intended for me I dream of a day when my main job would be staffing an outpatient clinic for breastfeeding families.
I have been a hospital based ibclc rn for 16 years.
Thank you for posting!
Thank you for putting in “black and white” what is similar to a typical day in our hospital setting. Our services have just been reduced to 1.4 FTE according to a “benchmark” for 2000 deliveries annually. I’m afraid that we will have to significantly reduce what we do to stay within the 8 hours a day 7 days a week that we are allowed. There are now only 2 of us down from 4 covering 2.4 FTEs 3 years ago. That said, I can’t imagine doing anything else. I too have found a passion in what I do and feel called to this profession in which I have served for 20 years.
I would love to hear more about how you attained your clinical hours while studying for the IBCLC exam. I am interested in working toward this certification, but as I am not an RN, I don’t know how I would accumulate the necessary hours (& if/how I would be able to land a job without a nursing degree). Can you please elaborate? Thanks!!
Thank you all for your responses! I honestly feel that in the hospital the most important thing we can accomplish is to educate and empower other healthcare providers to assist mothers with latch, positioning, and basic problem-solving. We are supposed to be the second line of defense and are qualified to provide more complex assistance and are meant to be a resource for other healthcare providers in the same way that a Registered Dietitian can help a physician who is treating a diabetic with special circumstances (i.e. other disease or condition concurrently.)
I have been fortunate to have been mentored by an IBCLC who had the foresight to create a job description “umbrella” which includes Certified Lactation Educators in the role of supervised lactation support. This allows the type of critical clinical skills experience which is necessary to sit the boards and become an effective IBCLC. Then when one attains the credential, the transition is seamless – I did the same job the day after I received my credential as I did the day before, only now my work falls under my own professional licensing and not hers. The issue of how to accumulate appropriate clinical hours is one of the biggest facing our profession today. I am putting together some thoughts on that specific topic and plan to share on my blog very soon. My thanks to all of you for the work you do to help moms and babies!
I am a newly graduated RN in love with the maternal/child/breastfeeding world. I have started my path in nursing and will be taking a CLC class next week. I would love to be an IBCLC! Thank you for writing about a day in your life working as an IBCLC. It has confirmed to me that I am going in the right direction. I hope to be in your shoes one day. Congrats on all of your accomplishments and making a difference in the lives of all the mothers and babies you interact with. God Bless!