by Adara Blake, MS, CCC-SLP, IBCLC
adaranblake@gmail.com
As a Speech-Language Pathologist and International Board Certified Lactation Consultant (IBCLC), I’m proud to combine my understanding of swallowing and barriers to safe feeding with an understanding of the physiology and mechanics of lactation and breastfeeding. As breastfeeding rates rise, the expectation that healthcare providers can provide adequate breastfeeding support will also rise. While our understanding of feeding and swallowing as SLPs tends to be based on bottle feeding, I believe it is the responsibility of clinicians working with infants to familiarize themselves both with physiologic breastfeeding, and how to intervene when breastfeeding is compromised. Too often breastfeeding and the provision of human milk are written off as “unrealistic” or secondary to bottle feeding. In my experience this is typically due to a poor understanding of how breastfeeding works. It is possible to support mothers in achieving their breastfeeding goals, while keeping our patients safe and meeting reasonable expectations for PO intake.
Suggestions for improving your breastfeeding knowledge and skills:
- Familiarize yourself with physiologic breastfeeding. It’s very hard to recognize a problem and intervene if you don’t know what “normal” looks like. This may mean watching YouTube videos of breastfeeding mothers or asking to shadow a local Breastfeeding Support Group. Stanford has an excellent website, “Getting Started with Breastfeeding” with videos and written information covering basic breastfeeding topics. https://med.stanford.edu/newborns/professional-education/breastfeeding.html
- Shadow an IBCLC. Hopefully you have access to a Lactation Consultant at your institution, and perhaps could even co-treat with an appropriate patient or two. If not, I’d encourage you to find out who provides outpatient lactation support in your community. If you’re confused or concerned about a practice that you observe, ask questions. Consider that just as there are doctors, nurses, and dieticians whose recommendations you may disagree with, you may need to work with more than one Lactation Consultant before you find one that you feel comfortable collaborating with.
- UC San Diego’s Supporting Premature Infant Nutrition (SPIN) is aimed at supporting breastfeeding and provision of human milk for infants hospitalized in the NICU. The website includes videos, examples of feeding protocols, and parent handouts. https://health.ucsd.edu/specialties/obgyn/maternity/NEWBORN/NICU/SPIN/Pages/default.aspx
- A text that may be of particular interest to SLPs is Supporting Sucking Skills, by Catherine Watson Genna. This book provides specific suggestions for breastfeeding intervention when working with medically compromised infants.
- Unfortunately I have not come across many CEU’s specifically aimed at SLPs, but there is currently an online presentation on SpeechPathology.com titled, “Breastfeeding in the NICU: The SLP’s Role in Lactation” with a 4/5 star rating. You might consider taking breastfeeding courses aimed at RN’s.
- If you are seeking a more thorough training, the Certified Lactation Counselor (CLC) training is a 45 hour course followed by up to 2.5 hours of practical and multiple choice exams. Trainings are offered through the US and Canada on a monthly basis. Certification lasts for 3 years and 18 hours of continuing education are required to recertify. More information can be found on the Healthy Children’s Center for Breastfeeding website: http://www.healthychildren.cc/clc.htm
- IBCLC certification can be achieved through three “pathways;” 90 hours of didactic training are required, and clinical hour requirements range from 300-1000 hours depending on the pathway. Candidates must then take a certifying exam that is offered twice yearly. Certification lasts for 5 years; IBCLC’s have the choice of completing 75 education hours or retaking the exam every 5 years, and are required to retake the exam every 10 years. More information can be found on the International Board of Lactation Consultant Examiners website: http://iblce.org/certify/pathways/
This is really great information! Thanks so much for compiling so many fantastic resources!
Hi Adara –
I really appreciate the excellent information. It’s nice that you understand perspective from both sides. There’s seems to be overlap in what we do as SLPs/Feeding specialists and what IBCLCs do with breastfeeding support. I’m not a breastfeeding expert and defer to IBCLC in that regard. I see many babies and moms for functional feeding assessment who are also being following by IBCLC. But these babies are often still struggling. Collaboration and feedback from IBCLC with these shared patients regarding my eval and impressions isn’t always well received or even ignored to the potential detriment to baby. If a baby is showing s/s of aspiration when nursing, that should not be dismissed. I’m also part of transdisciplinary study group including pediatric dentists, body workers, SLPs/feeding specialists, IBCLCs. It often feels like the IBCLCs don’t understand the role of SLP in infant feeding dx/tx and we are somehow stepping on their toes (or turf) so to speak. How do you differentiate roles/responsibilities of SLP/Feeding specialist and IBCLC? Thanks again.
Hi Dana,
I certainly see why you might be frustrated! It’s great that you are able to recognize your colleagues’ expertise and defer to them when appropriate, naturally you expect that same consideration in return. I feel a lot of the animosity comes from the simple fact that as SLPs, we have the “power” to decide that it’s not safe for a baby to breastfeed; this inherently makes the relationship between SLPs and IBCLCs unbalanced. I think ultimately the only way to improve your colleagues’ understanding of your expertise and why you make certain recommendations is to respectfully confront them with your concerns and provide education – and invite them to do the same. This may mean addressing these issues outside of individual patient care. Unfortunately our reliance as SLPs on bottle feeding for assessment and intervention is just flat out frustrating to lactation consultants, myself included. Even if the answer is ultimately “no,” I think it’s important to ask in good faith if there is a breastfeeding intervention that can address the same deficit that say, using x level nipple might (like pumping through mom’s initial let down or upright positioning). I feel strongly that just as, when reasonable, we find ways to preserve bottle feeding skills when a patient has dysphagia (say, by allowing a pacifier dips), we should effort to find ways to preserve breastfeeding (perhaps by allowing a few minutes of non-nutritive breastfeeding immediately after mom pumps). Feel free to reach out via email if you care to discuss further!
Thanks so much, Adara! I have a a few more questions so I’ll touch base via email. 🙂
Fantastic reply and I agree 100%. 🙂 Love this post and your valuable information.