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New Guidelines for IBCLC Certifying and Recertifying from 2020 and beyond

by Lorraine O’Hagan IBCLC.

 

Here is a spreadsheet of the clinical practice calculator  from the IBLCE site. It is a good example how to document hours.
Here is a presentation made by Lorraine O’Hagan IBCLC at the 2021 ALCI Spring Study Day.
Here is the link to the Recertifying information on the IBLCE website.

Meg Nagle, IBCLC “Supporting Families Through the Tongue Tie Journey” Reviewed by Tara Durkin

Breastfeeding Insight Online Conference (September 1-December 31, 2020, extended to January 31, 2021) on www.breastfeedingconferences.com.au

The Breastfeeding Insight Online Conference this autumn brought together healthcare professionals and academics from many different disciplines and perspectives on aspects of lactation and breast- and chestfeeding that we don’t always get to hear at conferences. All the talks offered food for thought and opportunities for growth in practice. Meg Nagle’s presentation on supporting families through their tongue tie journeys aimed to help rescue discussion around tongue tie from clinical debates among HCPs (e.g. the best way to assess tongue tie) to bring the focus back on the individual mother and baby. Nagle (“The Milk Meg”) stresses the importance of good listening skills, which she notes can take time to develop, and offers some valuable tips and techniques for IBCLCs to keep women and babies and their unique tongue tie journeys at the centre of care. In preparation for her talk, Nagle posed a question on social media inviting parents with experience breastfeeding a baby with tongue tie to tell her what they’d love HCPs to know about their tongue tie journey; it was enriching to hear those parents’ comments and the voices of Nagle’s clients guiding and shaping her talk. I’ll share some of the talk’s key messages.

 

The IBCLC as detective – taking a client’s history as art

Families who come to IBCLCs are often experiencing and exploring a wide array of issues and concerns. In order to really help a mother and baby, Nagle says, it is up to IBCLCs to be like detectives, asking questions to untangle what is going on for the particular dyad, as all mothers and babies are on unique journeys that don’t fit a mould or predetermined list. When taking a mother and baby’s history, asking key questions – and really listening to the answers, trusting the mother’s instinct and tuning into what her goals are – can help put the pieces of the client’s unique jigsaw together and support the mother’s confidence. Nagle suggests asking

  • How does it feel for you?
  • Does your baby effectively and efficiently drain the breast?
  • What are you feeling concerned about?
  • Is your baby settled when feeding?

 

IBCLCs are not magicians

Nagle stresses that lactation supporters need to start from the basis of listening well and trusting women’s intuition – especially when it comes to tongue tie, an area in which a great deal of research still needs to be done. While IBCLCs have their own professional expertise and knowledge based on the best available research, breastfeeding families need to be supported and trusted to find their own way, exploring the suggestions they’re given, and to come back to the LC if things aren’t improving. A referral to another professional such as a craniosacral therapist, speech and language therapist or dentist may be appropriate. At the end of the day, Nagle says, it’s detrimental that professional egos and assumptions about what’s going on don’t get in the way of giving the best possible support and building a mother’s trust in herself as a parent.

 

Consider your questions

Nagle stresses that mothers know how to describe how breastfeeding feels – we just need to ask the questions that prompt them to tell us. For example, how we ask women about pain is important; some mothers might not describe uncomfortable or suboptimal breastfeeding as “painful” so we need to be more specific. Instead of using a 1-10 pain scale, Nagle uses a language-based scale, e.g. “Do you feel a gentle pull that you barely feel, or pain/discomfort?” “Are you feeling a sensation like a chomping or clamping?” and so on.

 

Individualised, empowering care plans

Care plans, Nagle emphasises, have to start with the mother’s goals. Every plan will be different based on her goals and what she sees as her biggest challenges. Secondly, care plans always need to include options and alternatives, including having a tie release and not having a release; it’s important to discuss the known benefits, risks/side effects and alternatives of all the options with the mother. Thirdly, the care plan needs to include a range of positioning and attachment suggestions and alternatives that support the dyad before and after a release, or if the family decides not to release the tie. Skin-to-skin and laidback positions which support self-attachment, the least invasive techniques which activate innate skills, are good to try first. However, these may not work for everyone, or may not work right away. Alternatives such as side-lying, upright positions such as koala on an exercise ball, latching on while moving around and/or using the “flipple” technique may work better for different dyads at different times.

 

Never assume what mothers and babies are capable of

Nagle encourages IBCLCs not to shy away from offering a feeding option because they are worried it will be too much for the mother. She gave the example and showed a photograph of a mother tandem feeding her newborn twins, each using an at-breast supplementer with expressed breastmilk. Give women options, and they can explore, with support, what is right for them.

 

As a longtime Cuidiú breastfeeding counsellor preparing to take the IBCLC exam later this year I appreciated Meg Nagle’s presentation because it illustrated how my experience as a breastfeeding counsellor, and years of practicing active listening (two ears, one mouth, to be used in that proportion) can and should be put to good use in my future practice as a lactation consultant (fingers crossed!).

 

Tara Durkin February 2021.

Tara received a bursary of €50 from ALCI to virtually attend the Breastfeeding Insight Online Conference.

ALCI All Ireland Breastfeeding Spring Study Day 2021

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual breastfeeding Study Day online this year, to enable members to update their knowledge and skills while staying apart to stay safe. (ALCI Spring Study Day 2021 Timetable.) The Study Day will be live on Saturday 13th March and is for ALCI members only. There is a fantastic line up of speakers including keynote speaker Kathleen Kendall-Tackett IBCLC.

 

Kathleen Kendall-Tackett IBCLC is a health psychologist and International Board Certified Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett is Editor-in-Chief of two peer-reviewed journals: ​​Clinical Lactation and Psychological Trauma. She is Fellow of the American Psychological Association in Health and Trauma Psychology, Past President of the APA Division of Trauma Psychology, and a member of the APA’s Publications and Communications Board. Dr. Kendall-Tackett specialises in women’s-health research including breastfeeding, depression, trauma, and health psychology, and has won many awards for her work including the 2017 President’s Award for Outstanding Service to the Field of Trauma Psychology from the American Psychological Association’s Division of Trauma Psychology. Dr. Kendall-Tackett has authored more than 460 articles or chapters and is author or editor of 38 books. Her most recent books include Depression in New Mothers, 3rd Edition (2017), Women’s Mental Health Across the Lifespan (2017).

 

Other speakers include Nicola O’Byrne IBCLC who will present the topic of Moving On From Tongue Tie Focused Lactation. During this interactive presentation the participants will learn about the history of tongue tie division from an Irish perspective. Nicola will discuss her learning path and how current research has changed practice.

 

Other speakers include Liz Greene IBCLC who will speak about Breastfeeding The Late Pre-Term Infant; as well as Liz O’Sullivan PhD and Aileen Kennedy BA who will address The Irish Experience Of Infant And Young Child Feeding During COVID-19.

 

During the live online study day, participants will be welcome to submit questions and time will be allocated at the end of each session for answers. ALCI anticipate a lively interactive day with a difference, and encourage as many members as possible to join. Following each webinar there will be a live interactive session to generate discussion and promote interaction. The study day will be recorded and made available for a further three days, for ALCI members to review.

 

At a time like no other, ALCI are proud be offering online education to members, while staying apart to stay safe. The Study Day costs € 50 and is for ALCI members only. New memberships are welcome, € 60 for non IBCLCs and € 50 for IBCLCs with membership lasting until January 31st 2022. Email info@alcireland.ie with any queries.

 

ALCI Spring Study Day 2021 Timetable

Why Postnatal Recovery Matters reviewed by Kathryn Downey PHN IBCLC

Pinter and Martin present this concise book in the series of why it matters.  This covers a range of topics from fertility through to starting solids and all in between.  This little book delivers a wealth of information with both fact and anecdotal passages of mother’s own experiences coupled with some lost cultural traditions and those that continue despite mammoth changes in both Eastern and Western societies.

 

Messenger introduces her topic by describing postnatal care as the poor relation of the birthing world.  She identifies how the shift in modern thinking places more value on the newborn child and it’s needs than the needs of the new mother.  Messenger bases her insights on 10 years of interaction while caring for and supporting women on their journey to motherhood.  She identifies that our modern culture has created a system which “perpetuates the myth of the perfect motherhood”.  This she partially attributes to our dependency on social media which leads to a vicious cycle of falseness and inadequacy.  She gives a very honest overview on the lack of postnatal support aimed at the birthing mother.

 

Messenger gives a brief but insightful description of the almost lost traditions of nurturing the postnatal mother and the importance of doing so.  Messenger a Doula with a background in science lays out the very essence of the importance of allowing mothers to recover from pregnancy and birth while re-birthing themselves, as mothers.   Messenger presents the array of postnatal practices of Asian communities where the new mother is nourished, massaged and surrounded with rituals which celebrate, her, in her new role, as a new mother.  A practice which she claims was once celebrated and treasured by all societies.

 

Messenger dedicates a chapter to each of the elements Rest, Food, Social Support and Bodywork among others detailing how to achieve each whether in a nuclear or extended family.  She clearly indicates how the new mother requires and will thrive on hands-on support, but also detailing how new parents can provide these elements for themselves.  Messenger balances this by emphasising that new mother’s need not nor should not try to be all things to all people – being a super mum!  As this just won’t work, encouraging accepting help, be it from family or friends or buying in that help from a skilled helper.

 

Messenger includes special circumstances in the closing chapters of this little book.  These cover situations of single parenthood, admission to NICU and the most dreaded of all scenarios when a baby dies.  She goes on to acknowledge the taboo surrounding baby loss and pregnancy loss and how when this dreaded event occurs the new mother needs support more than ever.  She details the same tenets of support are necessitated – Rest, food, bodywork and social support – how right.

 

In concluding this book Messenger acknowledges how incredibly similar and ubiquitous post partum practices are around the world which are not such a distant tradition as imagined.  Finally, Messenger proposes if “we nurtured new mothers …there is the power to change society as a whole” a long-term cost saving exercise.

 

As a midwife I found this book intriguing, identifying all that we do not do for new mothers as well as all the high expectations we project upon them, the expectations we accept and take for granted.  It highlights our misplaced focus on just the care of the baby in the post partum period.  As a mother this book identifies the mis-placed stereotypical societal attitudes of motherhood-something which we can all help to change.

How can we help when a tongue tie procedure is not possible? By Meg Nagle IBCLC Reviewed by Dr. Vanessa Stitt

GOLD Learning Online Tongue-tie Symposium 2020
Date: September 14, 2020

Meg starts with listing her objectives- to describe the positions that tend to work best for babies who are having trouble latching, to explain how planning with the family helps leads to better outcomes, and to discuss possible challenges that might arise and how to best support families through them.
Factors that may lead to a tongue release not being possible or preferable are geographical, financial, cultural or personal preferences, or availability of services, especially in the light of COVID. Listening to the parent’s individual and personal preferences around feeding is paramount.
Meg describes the different symptoms of ties -the most common being infant’s inability to initiate and maintain a deep latch, to drain the breast efficiently and effectively, and maternal nipple pain. She explains colic appears to be linked to ties because digestion starts in the mouth and so ties can affect that first step in digestion, but that more research is needed.
Meg describes IBCLCs as detectives, not magical! It is up to IBCLCs to figure out what is going on with the breastfeeding dyad, and address these issues by offering different options to mom. She describes how to put the pieces together with four cardinal questions– how does it feel for you? Is your baby settled during feeding? Does your baby effectively and efficiently drain the breast? What are you feeling concerned about?
Meg states that there are many different tongue-tie assessment tool kits, and how this can lead to conflicting advice, but emphasizing the importance of symptoms, not just the oral assessment. She advises against the use of the term “mild” or “severe” tie, and the term”the latch looks fine” as being unhelpful. There is either a restriction causing issues with feeding, or not. How she asks the question of maternal nipple pain is important -is breastfeeding going to be sustainable in the context of this pain, or not?

• Latching and positioning – videos show babies diagnosed with tongue-tie. Video one shows a shallow latch, basically nipple feeding or straw feeding. Video two shows a baby struggling to initially latch, and difficulty maintaining suction. She suggests that we take the least invasive approach first.
• Techniques – Meg reminds us that laid back breastfeeding, self attachment and side lying has an evidence base (Genna 2015). The more hands on flipple technique is a second line option, with more maternal input. She has found that the half-koala/football upright hold, with a pillow providing baby some support at the back, in combination with self attachment or flipple can help. The best positioning is what works for the breastfeed dyad – offer different options. Supply lines like SNS can come in different options including homemade options. A plan should include short term and longterm goals, with reassessment and follow up. This plan must be formed by asking questions – are you feeling that you can continue to breastfeed as things are going now? Is getting a release an option if things don’t improve? Do you feel as though this plan that we’ve made is working for you? Outlining the different possible outcomes are also important – how does mom feels about these outcomes?
• Evidence, research and the internet – Meg makes the point that the internet often acts as a “broker” between parents and healthcare professionals. Linking with local release providers to keep up to date on current research is recommended. Giving parents up-to-date clinical evidence about the procedure is paramount.

 

Dr Vanessa Stitt September 2020.

Vanessa received a bursary of €50 from ALCI to virtually attend the GOLD Learning Online Tongue-tie Symposium 2020.

ALCI 2020 Conference Online

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual breastfeeding conference online this year, to enable members to update their knowledge and skills while staying apart to stay safe.  The conference will go live on Saturday 26th September and is free to all ALCI members (join here) .  This date as always will coincide with the beginning of National Breastfeeding Week which takes place from 1st to 7th October.  There is a fantastic line up of speakers including Lyndsey Hookway IBCLC and Sleep Consultant.

 

Lyndsey is a co-founder of the Holistic Sleep Coaching Programme as well as renowned author of the book Holistic Sleep Coaching.  Lyndsey, an international Speaker has worked with infants and children for almost 20 years, and regularly teaches health, lactation and childcare professionals.  Lyndsey is a passionate believer in gentle responsive parenting that never compromises on infant mental health or feeding.  Lyndsey will present a live webinar on helping families with sleep issues while supporting responsive feeding and attachment.

 

Other speakers include Anne Fallon who will present the topic of Supporting Traveller Women in Ireland to Breastfeed; Denise McGuinness and Marie Conway will provide an update on the findings of The Latch On Study; Carol Smyth will present a case study on the establishment of breastfeeding in a baby with  Congenital Arhinia and Caoimhe Whelan will present on Supplementing at the Breast/Chest exploring the why, when and how.

 

During the online conference participants will be welcome to submit questions and time will be allocated at the end of each session for answers.  ALCI anticipate a lively interactive conference, with a difference and encourage as many members as possible to join on the day.  Following each webinar there will be a live interactive session to generate discussion and promote interaction and participants are encouraged to settle in with a drink of their choice to enjoy the catch-up.   The conference will be recorded and made available for a further week to ALCI members to review.

 

Similar to other years, three Annual Scholarships will be awarded; one to a first time IBLCE candidate from a non medical background, one to a first time IBLCE candidate from a medical background and one to a recertifying candidate. Each candidate will receive a €150  book fund and € 250 towards the cost of the exam.

 

In a year like no other, ALCI are proud be offering online education to members, while staying apart to stay safe.

 

Email info@alcireland.ie with any queries.

The WHO Code on the Marketing of Breastmilk Substitutes

by Stephanie Murray

It’s the week of WHO Code’s 39th birthday and a great opportunity to heighten awareness of “the Code” to all organisations and individuals that are passionate about infant and young child feeding.  ALCI, as part of its goals, supports the full implementation of the International Code of Marketing Breastmilk Substitutes and subsequent resolutions of the World Health Assembly.

 

 

What is it?

The Code comprises of the original WHO/UNICEF International Code of Marketing of Breastmilk Substitutes adopted in 1981 and all updates to this, in the form of resolutions https://www.who.int/nutrition/publications/code_english.pdf These are made every two years or so to strengthen and clarify the code at the World Health Assembly.  The Code is an internationally agreed code of practice, designed to protect breastfeeding by preventing unscrupulous marketing and claims about breastmilk substitutes. This incorporates infant formulas, follow-on formulas and any other food or drink, feeding bottles and teats along with setting standards for the labelling and quality of products. As of April 2018, 136 out of 194 countries had some form of legal measure in place covering all, many or few provisions of the Code. Irish affiliation and laws are found here  http://bflgireland.ie/irish-laws/

 

What does it mean to me as me as an IBCLC-private/Hospital?

The IBCLE’s Code of Professional Practice states that a crucial part of an IBCLC’s duty is to protect the public health of mothers and children and therefore adherence to the principles and aim of the WHO Code and subsequent relevant documents of the World Health Assembly is vital. Also, ILCA, the professional organisation of an IBCLC endorses all divisions of the WHO Code and encourages all members to do same. The HSE- National Breastfeeding Strategy Committee approves and recommends  the Who Code as per their fact sheet for health professionals https://www.hse.ie/file-library/the-who-code-of-marketing-of-breast-milk-substitutes.pdf.

 

The main points in the Code for healthcare workers both professionals and volunteers to adhere to are:

 

  • no advertising of breast-milk substitutes and other related products to the public: this can relate to advising on products such as pumps, nipple creams etc with clients and promoting companies that adhere to the code is preferred practice. Important also not to recommend any particular brand of formula to the formula feeding mother.
  • no free samples to mothers or their families: Again, here be mindful of the companies we as health carers obtain feeding accessory products from and provide families with such as nipple shields/creams, latch aids etc. Consider if these companies are code-compliant and the claims that they make – eg. are the claims they make about healing cracked nipples  clinically proven ?  Also included here would be to involved with events such as baby fairs that supply mothers and their families with loads of free samples.
  • no promotion of products, i.e. no product displays, posters, calendars, or distribution of promotional materials. This encourages brand recognition and a means of gaining media exposure and what better way than to get a well-respected person endorsing or being photographed with your product or logo. Individuals sharing information online or on social media in relation to products within the scope of the code is also a violation. It is very difficult to keep up to date with all companies that are code compliant as this is ever changing as companies merge and acquire subsidiaries. it is important to be aware that companies that maybe code compliant but owned by a code violating company that they are to be considered the same of the parent company. A heightened awareness prior to sharing information online is advised.
  • no donations of free or subsidised supplies of breast-milk substitutes or related products in any part of the health care system.
  • no company-paid personnel to contact or to advise mothers: This can relate to a healthcare worker being asked to speak at an event for mothers that is sponsored by a company that violates the who code.
  • no gifts or personal samples to health workers: This includes attending events and having dinner provided, research funded, conferences paid and invites or any personal gain. In cases where an event or some part of an event is sponsored by an entity not meeting its obligations under the International Code, the IBCLC/healthcare worker may refuse to attend that event; attend, but not those portions sponsored by this entity; or waive a speaker fee, but acknowledge to attendees this disassociation.
  • no pictures of infants, or other pictures or text idealising artificial feeding, on the labels of products
  • information to health workers should only be scientific and factual: Healthcare workers should be able to identify research that could indicate bias or a conflict of interest. The Code permits educational activities as long as no affiliation to companies with a return of interest is involved, they are scientific and factual
  • information on artificial feeding should explain the importance of breastfeeding, the health hazards associated with artificial feeding and the costs of using artificial feeding
  • all products should be of a high quality, and unsuitable products, such as sweetened condensed milk, should not be promoted for babies.

https://www.llli.org/wp-content/uploads/August-2020-code-graphic-final.png?fbclid=IwAR2H3kPt4sz-vYqZDV_uJb8A946kwePSTBPeeLSwiqpDc9itZ36p9UDHQu4

 

It is important to note that companies can be associated with products that are under the scope of the WHO Code but as long as there is no marketing of them then no violation has occurred. Mothers who decide to use infant formula should be given one-to-one or small group instruction on the safe preparation on formula feeds in the postnatal period. Also, to note that any product covered under the International Code may be sold when medically indicated and an IBCLC/healthcare worker should explain the clinical use, the required duration of the use and the risks of the products.

 

The WHO Code states that non-governmental organisations, professional groups, institutions and individuals should monitor for Code violations and report violations.  If you suspect you have come across a Code violation you should bring this to the attention of

 

An in-store Code violation, you might like to bring it to the attention of management as a first port of call. If this is unsuccessful you should contact the FSAI.  FSAI is the body tasked with implementing and enforcing EU and national food law only. Report a Code violation via the FSAI online complaints form here. Also you can choose to inform The Baby Feeding Law Group Ireland  by email at bflgireland@gmail.com.   The Advertising Standard authority of Ireland (ASAI) accepts violations relating to radio, tv or internet.