Saturday, February 18, 2012

Breastfeeding Counselor/Lactation Consultant

Hello, finally I start writing again in 2012. This first article of the new year may be a bit too specific and detailed but I would appreciate you taking the time to read it.
You may have heard some things about breastfeeding if you are pregnant, or know someone who is pregnant. You may have even heard about a person called a Breastfeeding Counselor or Lactation Consultant and asked “Who is this person?” Or maybe you thought why need a breastfeeding counselor, isn’t breastfeeding a normal natural path anyway? Don’t worry; these are common questions, and I plan to clarify the meaning of these in this article.
I would like to start by clarifying the difference in the meaning of these titles. This is important especially in Turkey because this relatively new profession was started in the USA through a group of women who volunteered to help mothers and babies breastfeed in the 1950s. As this profession evolved into more pronounced certifications, through the support of the World Health Organization (WHO) and UNICEF this profession became Internationally standardized and an essential part in promoting breastfeeding in the world. Thus, most literature in Breastfeeding and Human Lactation is in English. Although many books are translated into a variety of languages, the widely used textbooks in this area are not yet translated into Turkish. In the USA, a Breastfeeding Counselor sometimes referred to as a Lactation Counselor or Breastfeeding Educator is an individual usually certified through a National Association. Their certification is usually based on specific experiences and knowledge, and in order to continue their credentials they are required to participate in continuing education. In Turkey, from my experiences, these individuals, collectively referred to as ‘Emzirme Danışmanı’, may or may not be certified through an International or National Association and their certification is not necessarily standardized. However, Lactation Consultants, short for International Board Certified Lactation Consultant (IBCLC), are individuals internationally certified through standardized and regulated Associations. To become and IBCLC, one is required to gather certain hours of experience in helping mothers and babies breastfeed and then pass an International exam. This process is regulated by the International Board Lactation Consultant Examiners (IBLCE). Then, the practice of an IBCLC is regulated by the International Lactation Consultant Association (ILCA). This process and the Associations are supported by WHO. So, the difference really lies in the meaning of the words Counselor and Consultant.
Now that I’ve clarified the meanings of a Breastfeeding Counselor and Lactation Consultant, I would like to continue with explaining what these individuals actually do. This is important. In short, the aim of a Breastfeeding Counselor and Lactation Consultant is the same: To promote, protect, and support breastfeeding. However, there are some slight differences in the responsibilities of an IBCLC. An IBCLC is a consultant specialized in providing the needs and concerns of the breastfeeding mother-baby pair. Their responsibilities are determined by WHO and ILCA. These are:
  • To prevent or diagnose and solve any breastfeeding difficulties.
  • To evaluate, diagnose, solve, and follow up on any breastfeeding difficulties that may occur. Some of these issues are: Latching problems, engorgement, infections, mastitis, or premature, weight issues, allergies, and other special situations.
  • To promote, protect, and support breastfeeding worldwide. This can be achieved by offering breastfeeding classes or personal lactation consultations to women, families, the public, and health professionals.
  • When needed working with a multidisciplinary health team to help diagnose, and solve the breastfeeding issue that a mother-baby couple is experiencing. This includes referring mother and baby to other specialized health professionals.
  • Follow the ILCA Ethics Code. This is also known as the WHO Code: International Code of Marketing Breastmilk Substitutes. This includes several princibles that generally aim towards providing the baby with safe breastmilk substitutes in the rare case when breatmilk is not available. In summary, the artifical feeding needs to be offered in a way that resembles breastfeeding as best as it can, and the correctly labeled artifical substitute can only be offered to a mother by a health professional. No free breastmilk substitutes are to be given to health professionals or mothers.
Actually, it is possible for a Breastfeeding Counselor to have similar qualities, experiences and education of an IBCLC. However, the part that is especially important is that the Breastfeeding Counselor in Turkey may not be regulated by WHO or a National Specialized Association. Of course I’m not saying that in Turkey you can only rely on the advice of an IBCLC not a Breastfeeding Counselor. I am only hoping to help you understand the difference between these two qualifications in order for you to choose the counselor or consultant that meets your specific needs.
Currently, in Turkey, there are only two IBCLCs including me which is a small number compared to other countries. Universally, almost every country has several IBCLCs. They usually work in hospitals, birth centers, clinics, or independently. The concept of a Breastfeeding Counselor is becoming prevalent in Istanbul and in 2011 the Ministry of Health has started offering Breastfeeding Courses to Nurses. However, in many countries, when there are difficult breastfeeding situations that require medical attention, an IBCLC consultation is preferred. And more IBCLCs are preferred to work as the Breastfeeding/Lactation Consultant at a hospital. In my experience, the breastfeeding courses offered in Turkey are limited and remain very basic, and continuing education of a Breastfeeding/Lactation Consultant is not routinely encouraged. There seems to be no special course that examines Breastfeeding and the Human Lactation scientifically which could educate individuals to become an IBCLC. Since research on breastfeeding benefits and lactation still continues extensively and may sometimes change what we offer mothers and babies, it is especially critical that a Breastfeeding Counselor or IBCLC stays up to date.
Furthermore, volunteer based support groups for breastfeeding mothers are limited in Turkey. The first La Leche League International (LLL) group was established in Ankara in 2011. This is an internationally well-known support group, however it is not professional counseling, it is designed as a mother to mother support group to help breastfeeding mothers establish a community where they can share their experiences and continue breastfeeding. These kinds of support groups usually help mothers successfully breastfeed for longer.
In consequence, according to the 2009 UNICEF data on Turkey, the babies who exclusively breastfed for the first 6 months, and the babies who breastfed up to 2 years of age are 42% and 22%, consecutively. Compared with World standards, these are very low percentages. There is still a lot to be done to promote, protect and support breastfeeding in Turkey. What YOU can do is inform your friends and community about the concept of a Lactation Consultant. You could start by promoting my services in Istanbul which are, Breastfeeding with Awareness Classes every 2nd Wednesday evening of the month and personal Lactation Consultations as home visits. Let’s support each other by sharing! 
English References:
In Turkey:
  • Book: The Womenly Art of Breastfeeding, by Weissinger, West, and Pitman, La Leche League, 8th Edition. (Turkish version: Emzirme Sanatı, La Leche League International, Gün Yayıncılık).