Leaders and Lactation Consultants
from LEAVEN, Vol. 28 No.
5, September-October 1992, pp. 75-6
by Mary Renard
LLLI Board of Directors
Vienna, Virginia, USA
Dear LLLI,
I'm concerned about what seems to be a growing trend. On the US television
program, "The Home Show," the mother of a five-month-old breastfeeding
baby remarked that the LLL Leader she contacted for help referred her
to a lactation consultant.
In five years of LLL leadership,
I have never found myself in a situation that required me to go beyond
my Area Professional Liaison Leader for information outside the realm
of my personal experience or LLL written resources. If we in LLL consider
ourselves to be the "world's foremost authority on breastfeeding," when,
if ever, is it necessary or appropriate for Leaders to refer mothers
elsewhere for information?
Betsy Liotus
Schaumburg, Illinois, USA
Dear LLLI,
Some comments made by a lactation consultant who is also a Leader have
left me feeling unsure of my abilities to help breastfeeding mothers
as a La Leche League Leader.
During a Chapter Meeting
this Leader expressed concern over what she perceived as a lack of follow-up
by LLL Leaders in the more complex problems of breastfeeding, e.g.,
slow-weight-gain babies and mastitis. She was talking about Leaders
who do not make home visits when the mothers need to be seen, the delay
in receiving appropriate LLL written information through the post, and
Leaders' inconsistency in calling mothers back within a couple of days.
Another Leader also said
that if we as LLL Leaders are not prepared to make follow-up calls,
visit mothers who need to be seen, or invite mothers into our homes
then we should not publish our telephone numbers on posters.
I need some help in sorting
out what LLLI expects Leaders to do and what lactation consultants expect
us to do as LLL Leaders in these situations.
Irene Deans-Dundas
Harare, Zimbabwe
Dear Betsy and Irene,
As Sally Tobin wrote in "Guidelines
for Active Leaders Who Also Work as Paid Lactation Consultants" (May-June
1990 LEAVEN, pp. 39-41):
It is important to note
that LLLI has no authority to define what lactation consultants can
or cannot do in their lactation consultant role. It is, however, equally
important to remember that only LLLI can define what the limits
and expectations are of the active LLL Leader.
LLLI's expectations for Leaders
are defined in THE NEW LEADER'S HANDBOOK. Leaders' basic responsibilities
are listed on pp. 3-4, and LLLI's expectations concerning follow-up
calls and home visits (which may take place in either the mother's or
the Leader's home) are listed on pp. 32-33.
It is true that in some
situations a mother and baby need to be seen. THE NEW LEADER'S HANDBOOK
lists some situations that may require a home visit:
- When a baby is refusing
to breastfeed or having trouble latching on,
- When a baby is not gaining
well and the usual management suggestions are not helping,
- When a mother has persistent
sore nipples and over-the-phone suggestions have not helped,
- When a mother needs a
breastfeeding- aid product, such as a breast pump or nursing supplementer.
Home visits and "hands-on"
help are within the scope of LLL leadership and are covered by Leader
liability insurance, despite persistent rumors to the contrary.
(The only exception is if a Leader is paid for her services. Only volunteer
help is covered under LLL's insurance plan.)* But home visits are optional
and are not considered part of a Leader's basic responsibilities. THE
NEW LEADER'S HANDBOOK goes on to say:
- If, due to family needs
or other factors, a Leader decides not to make a home visit when it
seems necessary, she has other options for making sure the mother
gets the help she needs.
- After consultation with
another local Leader, the Leader may make arrangements to have the
other Leader meet with the mother instead.
- If the monthly meeting
is being held soon enough, the Leader can make arrangements to have
the mother come there for help.... The timing of the meeting is an
important factor, since some problems need immediate attention.
- If no Leader can make
a home visit when it seems to be necessary, the Leader can refer the
mother to a qualified lactation consultant if the Leader knows one
in the area who would be able to help. In this case the mother should
be advised that the lactation consultant will charge a fee for her
service.
Sometimes Leaders (especially
new Leaders) who are unsure of their helping skills may feel tempted
to refer all mothers with complicated or unusual problems to other more
experienced Leaders or lactation consultants. But sending these mothers
elsewhere deprives a Leader of the opportunity to improve her skills.
Helping mothers is how we learn and grow in self-confidence.
It is also important to keep
in mind that every Leader (and lactation consultant), no matter how
experienced she is, will at some time find herself confronted with a
situation or problem for which she does not know the answer. At these
times, a good place to begin is to consult THE BREASTFEEDING ANSWER
BOOK, which was specifically designed to be used as a resource in these
kinds of situations. LLLI also offers many other written and people
resources for Leaders seeking informa- tion. See "Using LLL Resources
to Get Medical Information" (July-August 1991 LEAVEN, pp. 51-54) and
"When a Leader Doesn't Know the Answer" in THE NEW LEADER'S HANDBOOK,
pp. 25-31.
If you have never made a
home visit and would like to try but feel nervous or unsure of yourself,
before you are faced with a mother needing immediate help, try to find
another Leader who has done home visits. If there is no one in your
vicinity, write or call your District Advisor and ask if she knows of
a Leader you could contact. If a Leader who has done home visits lives
near you, perhaps she would be willing to talk to you about her experience
and offer suggestions--or even accompany you for moral support.
Elizabeth Hormann (Koln,
Germany), Publications Administrator for the Around the World Division,
writes:
As I read the letters about
Leaders referring to lactation consultants, I detect more than a little
defensiveness about the skills of LLL Leaders. It is a defensiveness
that I don't think is necessary any more than a general practitioner
needs to feel defensive about her skills in treating illness and helping
her patients stay healthy. But there will be times in her practice when
she will want a second opinion or will want to refer to someone who
specializes in a particular area. We recognize this same principle in
LLL when we go "up the chain" using the skills and varied resources
available through our District Advisors, our Area Professional Liaison
Leaders, LLLI, and the Health Advisory Council. It has always been clear
that no Leader knows everything.
Keep in mind, too, that
just as Leaders have different levels of helping skills, so do lactation
consultants. As Julie Stock wrote:
Lactation consultants may
be Leaders or non-Leaders with personal breastfeeding experience and
high levels of knowledge or they may be health professionals who have
never breastfed a baby but have been assigned to help breastfeeding
mothers and are expected to acquire information and skills as part of
their position. Some few women may simply proclaim themselves as lactation
consultants with little or no breastfeeding experience and no background
in the field of health care.
For this reason it is important
to take the time to get to know a lactation consultant and learn more
about her approach to helping mothers and handling breastfeeding problems
before referring mothers to her. One way to do this would be to invite
her to speak to local Leaders at a Chapter Meeting.
Kittie Frantz (Los Angeles,
California, USA), pediatric nurse practitioner and retired LLL Leader,
writes:
A true professional knows
when she is in over her head and refers to an appropriate source of
help that she has personally investigated previously. Having said this
I see a lot of LLL Leaders feeling disempowered because "they don't
possess a lot of technical knowledge." These Leaders refer [mothers]
often to a lactation consultant, forgetting that LLL's gift is knowledgeable
support and she does possess a skill to mother that mother. I would
tell [a Leader] to give what she has and refer only if it isn't working
or she feels truly out of her area of expertise.
Jimmie Stimpson (Greenboro,
North Carolina, USA), Leader and lactation consultant, writes:
[Leaders in my area] consider
the lactation consultant to be an additional resource [and] the lactation
consultant's availability [to be] a positive alternative for everyone
involved, particularly for situations involving repeated "hands-on"
care. This situation exists because the Leaders and lactation consultants
in our area have a mutual trust and respect for each other.
Cindy Smith (Anderson, Indiana,
USA), US Western Division Professional Liaison Program Advisor, writes:
The majority of Leaders are
capable of handling the majority of breastfeeding questions. Occasionally
there will be situations that need a more immediate response than an
individual Leader is able to comfortably provide. Since the health and
well-being of the mother/baby dyad must always be our prime consideration,
Leaders who find themselves in these situations are expected to offer
mothers whatever choices are viable in her community: referral to another
more experienced Leader or Professional Liaison Leader, referral to
a community-based lactation consultant, or referral to a supportive
health-care provider, if that is more appropriate. There can be no rules
or guidelines for these referrals because every community and every
situation is unique. Please remember that the choice of where to turn
next should remain the mother's and that she should be informed about
all possible alternatives.
Chele Marmet (Los Angeles,
California, USA), Professional Liaison Leader, International Lactation
Consultant Association Board Member, Coordinator, UCLA Clinical Lactation
Consultant Program, Director, Lactation Institute, writes:
When a Leader receives a
mother's call, she can do everything within her resources to help the
mother. If, however, there has been little or no improvement, she can
refer the mother and baby to someone with clinical skills, knowledge
and [if the referral is to a lactation consultant] (preferably) IBCLC
certification. When referring, the mother should be given choices. This
empowers the mother to control the outcome of her situation, and she
becomes stronger as a result. A referral should be followed up by the
LLL Leader to see how things are going. Once the problem is resolved,
the lactation consultant would [ideally] refer the mother back to LLL
for ongoing support and education, which is what Leaders are trained
superbly to do.
Leaders have much to offer
breastfeeding mothers in both normal and unusual situations. As Julie
Stock wrote in "Leaders ARE Lactation Consultants":
In the field of breastfeeding
management and lactation information, there is room for both LLL Leaders
and lactation consultants. Both offer services that would be greatly
missed if one or the other were removed from the community In our effort
to understand the role of the lactation consultant, it is vital that
we not diminish or misinterpret the role of the LLL Leader... The La
Leche League Leader gives our society an invaluable gift--one that is
only hers to give.
*LLLI Affiliates--Canada,
Canada Francais, Deutschland, Great Britain, New Zealand, and Switzerland--have
their own insurance where needed and Leaders in these affiliated countries
who are concerned about their insurance coverage should contact the
organization in their country for information.
Page last edited Sun Oct 14 09:31:24 UTC 2007.
