We know breastfeeding is the foundation for maternal and child health, and International Board Certified Lactation Consultants® (IBCLCs®) are the global experts in promoting and supporting it. Lactation Matters, in collaboration with the International Lactation Consultant Association® (ILCA®) Global Outreach Committee, is eager to highlight the work of IBCLCs around the world in a variety of settings. Do you have a story to share about your work in support of breastfeeding? Please contact Diana Cassar-Uhl at DianaIBCLC@gmail.com if you’d like your work or the work of a colleague to be featured here. Today, we’re sharing the story of Vicki Tapia, BS, IBCLC, RLC, and the time she spent providing breastfeeding support in the Dominican Republic.
In November of 2012, I served on a medical relief mission to the Dominican Republic (the first IBCLC the aid organization had ever sent on a brigade). After landing in Santiago, our group of 15 student nurses, 2 RNs, 4 physicians, a pharmacist, and I traveled by bus to a community about 52 km from the Haitian border. Each day, we traveled to a different village, where our physicians worked in either a converted school or church, seeing about 100 patients a day. Peace Corps volunteers, along with Haitian medical students, helped translate into Spanish (Dominicans) or Creole (Haitians).
My plan was to speak with all women of childbearing age, but this quickly morphed into talking with everyone who walked by my lactation station. I realized dads and grandparents might also benefit from the breastfeeding information I happily shared. I’d brought breastfeeding brochures (developed with Peace Corps volunteer input), pictures of my breastfed grandsons, and all my enthusiasm to promote “solamente el seno” (only the breast) for the first six months.
Isn’t it interesting how we expect one outcome and receive something different? I’d planned to spend my week assisting moms/babies with hands-on help. However, none of the mothers I met had newborns! Instead, I learned what life was like for a mother in the Dominican Republic. The C-section rate is 70 percent and the vast majority of women aren’t allowed to breastfeed for up to 24 hours after delivery, or until the anesthesia has “cleared their bodies.” I learned that if a woman receives magnesium sulfate for preeclampsia, she’s denied permission to ever breastfeed. I heard that mothers who choose to breastfeed are told by most doctors to start supplementing with a recommended formula on the first or second day of the infant’s life, so that exclusive breastfeeding is rare. How could I suggest exclusive breastfeeding if their health care providers were promoting the opposite?
Breastfeeding is seen as “old fashioned” by many young mothers (most start having children around 14 and are finished childbearing by their early twenties). On a positive note, I did encounter a couple of women during the week that appeared to have truly exclusively breastfed and one village elder who was the self-designated “lactation consultant,” so there were definitely glimmers of hope.
In retrospect, perhaps my most significant contribution was the information I shared on one of the days with Dr. Garcia (the local physician who accompanied our brigade) that magnesium sulfate use does not preclude breastfeeding (LactMed app). At our wrap-up meeting on the last day, when the brigade members were discussing preventing disease and illness and improving outcomes, I offered my opinion that the most important component is to start at the beginning by improving exclusive breastfeeding rates. Everyone readily agreed. Dr. Garcia interjected that it was clear to him how important it is to educate not only the women, but also the doctors, about the importance of exclusive breastfeeding for 6 months. He indicated that future breastfeeding promotion would be given priority and this would be in the written summary of our brigade’s visit.
He went on to share that in a meeting the previous evening with all the local doctors, he’d openly confronted the doctor of a mother who’d told me she wasn’t allowed to breastfeed because of magnesium sulfate and in the process re-educated the entire group of physicians.
Stories such as this highlight the importance of the IBCLC’s role in affecting positive change in our world. It’s our narrow focus that allows us to see to the heart of the matter, as applied to health care outcomes. My impact in the Dominican Republic may only have been one tiny step, but it was a step in the right direction.
Learn more about Vicki’s work in her article in Clinical Lactation, the official journal of the United States Lactation Consultant Association.
Vicki Tapia, BS, IBCLC, RLC, is a lactation consultant and former La Leche League leader, with over 30 years experience working with mothers and babies in both hospital and clinical settings. She has also had numerous articles published and spoken at breastfeeding conferences nationally and internationally.