79 | What makes Lactation Consultants Different from Other Perinatal Providers

Annie: Hey there, Leah, how are you?

Leah: I am doing well and just trucking along through springtime and it's really starting to get hot over here, but that's good because it means more pool days, which I can always get behind that. How about

Annie: you guys? Not hot yet, but getting, getting nice, getting to be spring weather and I'm actually driving upstate later this week to speak at the annual convention for the New York State Speech Language Hearing Association. I'm excited about it, just cuz it'll be a fun time away. I'm not really interested in any of the other programming. Like it's like, has nothing to do with babies. Uh, so I'm like, I don't know. But my talk that I'm giving is I've put together two talks I've given before. So the one I'm giving is called Hold on for one more day. Okay. Case coordination for lactation private practice. And I put together my hold on for one more day talk that I've given before, which is like following the client journey from first contact through like you're done, whatever that means. And then how to run an outpatient lactation consult, which is like, goes through like the nuts and bolts of like what actually happens, like went from the start of the visit to the end of the visit. And I kind of wanna show them how what we do is different from what they do. And there's a little bit of like advocacy in there for me, for the profession because you know, SLPs can do pathway one and become IBCLCs and do lactation. Without really understanding what lactation work actually involves. So I don't know. The way they scheduled it too is like my slot is longer than the other ones at that time. So like, oh wow. I don't know. Are people gonna leave early to get to another one? Is anybody even gonna come? Will I be screaming into the void? I have no idea. Yeah. Yeah, that's happening later this week.

Leah: I'm excited though. I think that's so helpful for other professionals that are working with young families to understand how our role can fit in and kind of the unique aspects of the work that we do. Because you're right, I don't think a lot of people get other professionals who are working with young families get how we're different and how what we do can contribute different information than probably anybody else's gathering. And also the value in that. I mean, it's so valuable. That's why today we wanted to talk about that very topic. Like how are we different? What do we do differently? You know, I think we need to figure out different ways. And I love that you're kind of. Taking charge on these different ways that we can communicate what we do and its value, but also how it's so different, you know? That's a big piece of advocacy for our profession and where people that might be referring can understand. You know the aspects and contributions that we can make to the healthcare team and how that information might not be able to be gathered from anyone else but the lens of a lactation consultant. So I definitely think this is an important conversation and this will just be a tip of the iceberg for the conversation cuz I feel like we had some really good points, but also there's like so much more to it than what we could ever talk about in the podcast. But it's a really great thing to keep this advocacy up cuz I feel like people need to know what we do.

Annie: No, they really do. I'm always surprised, like I, I guess I shouldn't be at this point, that sometimes people view our work or finding a lactation consultant the way they view finding a doula in that, like the most important thing is like, do they vibe with you, for lack of a better way of saying it. But you're like, okay, like some doulas, you know, are this kind of doula and others do it another way. And so you're kind of like, well, what. Like, what do I want? And a lot of that has to do with like what kind of birth you're planning and what you know, are you, are you planning to have interventions? And so some doulas are specialized in that. So sometimes like I feel like there might be a perception that you're like gonna find a lactation consultant. You're like, okay, well I need, my goal is to exclusively breastfeed, so I need this kind of lactation consultant, right? My goal is to give bottles when I go back to work. Or my goal is to exclusively pump. And kind of thinking that like you need, that's three different people that like that. Like the one, the person that can support you with bottle feeding is not gonna be interested in supporting you with exclusively breastfeeding or the other way around when really we are clinicians, we're like, okay, like. You would go to see a podiatrist if you wanna walk, if you want to run, if you wanna play tennis, if you wanna like sit on your couch, it's like it's a foot, right? Like I'm dealing with your foot, which Yeah. Is going to be doing many different things depending on what is happening in your life right now. Right. And so it's hard to help people understand, they just see us as this like touchy-feely member of the care team and Right. Not really understanding all the clinical training that goes into it.

Leah: Yeah, and I think that really starts with how we view the whole picture. You know, that we're really looking from that lens of like, you know, what is the human design normal? Like, how are these people, you know, supposed to work if. The human design is working normally, and then like finding where there is adaptations or compensations and all of that in any of those ways that a person would end up feeding slash you know, extracting milk or not, or whatever those pieces are. But I feel like our lens is so different than a lot of other clinicians and other people might be contributing to the team because I feel like our awareness of how human milk production and infant feeding is normal versus all the ways you can do it. You know, like all the ways that are possible versus like what's normal. And then we can kind of see where even on the ways that are possible, we could help improve it and help it. You know, be more like that normal human design, if that makes sense.

Annie: Yeah, definitely. I mean, our biological norm is competence. So like feeding your baby is something that, you know, lactating is the natural last stage of pregnancy. You get pregnant and your body is expecting to give birth to that baby, and then lactate at the end of it. So when there's an interruption in lactation, that's. Not the biological norm. Babies are born with reflexes for breastfeeding when babies aren't able to do it, we need to understand what is interfering with their competence. And then external things like returning to work and having a job where you're separated from your baby. That requires certain interventions and decisions and support that are. Adaptations on the biologic norm. And then what we can do is we can, as you said, support them in the most competent way possible. Just say like, well, what is your specific situation? And let's get you there in a way that is not just possible or like conforming to what somebody else thinks it should be, but what's sustainable for you. And in some cases, what's really gonna, I mean not some cases, all cases, what is going to best serve your relationship with your baby and the family dynamic that you want to have?

Leah: Yeah, absolutely. And that's because we also really see our job as working with two people. We're not. Thinking just the parent, just the baby, or only looking at one of those entities and not thinking about how the other plays a part in almost everything that the other one is doing, especially in those early stages, you know? And so, I feel like this just jumps into that idea of like, we're looking at the norm, but the norm comes with this family unit and looking at that as a whole and understanding that there's two parties that are part of this feeding journey that they're having.

Annie: Yeah. Cuz there's like, okay, what you want to do as the parent, there's what your baby wants to do as a totally different person. There's what is. Physiologically and also situationally possible for you and your family and all those things need to be taken into consideration. There's also what. Is possible for your baby and all babies need help. They all need help with something like I, I tell, like when I'm talking to families about bodywork, I'm always like, listen, I think every baby should get this because they all come out a little, like a little eek. You know, like that was a lot what, however, they were born. And so they need our help. And so identifying what supports your baby needs inside that entire frame of what does this family look like? And that's so different than I think that perception that some people might have about a lactation consultant. Maybe that's because of. Pathway one where people can just tack on IBCLC to their already medical license. That is just like you're coming in there to be like, well, what do you wanna do? Okay, that's great. Like, and I hope it's exclusively breastfeed cuz that's the only thing I know about and the only thing I care about. And like, the longer, like you and I have talked about this so many times, the longer we do this work, the more we're like, That's like literally the last thing I know how to do. Right.

Leah: Right. It's so true. And like being able to see where things are going wrong because you know where the norm kind of baseline sits and like if you don't. Have that awareness that if you haven't had that exposure from other professionals who you know, might tack on lactation, kind of looking from this, I dunno, maybe some book knowledge, but you're definitely not able to kind of see these two units working together and the interplay and the interchange maybe as much as somebody who's like, You know, in the trenches, day in and day out with these families, kinda seeing the challenges, but also seeing, you know, when it is quote-unquote kind of normal physiology, normal competency, you know? And I feel like it's really hard to communicate that because the way that you can get IBCLC tacked on, I feel like then we kind of have like these different segments of being an IBCLC or different. I don't know, ways that you could, you know, practice as an IBCLC that then make what you do and what you see and what you're capable of. Like a little bit different, would you say?

Annie: Yeah, definitely. I mean, I think like providers who are focused on the baby and the baby side of things, I think there's maybe more of a tendency to look at pathology or just to kind of go there and say, well, you know, here's like, I mean, not to pick on, I'm just gonna be meeting these speech-language pathologists this week, but Pathologist is in their name, right. You know, or even like a physical therapist or an occupational therapist. You go to these providers because you've identified that there's a problem, that there's a pathology that needs to be sorted out and, uh, worked through and corrected. And then on the, like the maternal side of things. I mean, first of all, we have all the parents that are just completely let down because the OB-GYNs are so waist down in their focus and there's not a lot of focus on lactation and there's so few birth providers that are really looking holistically. You know, here in New York it's really like, The home birth midwives and then a few of the, you know, midwives are, that are working in the hospitals that are really like empowering these parents in what's like your body can do amazing things. We are just really seeing these, these parents who just feel like everything is their fault. And that's something that I think if you're used, if you're used to dealing with parents who are bringing their babies to you, because. They've identified their baby needs help. That is so different than a parent walking in there and saying, my baby won't latch. I must be doing something wrong. And you and I, we see that all the time. They all say that. They all say, I just can't get the latch. Right. And meanwhile, like the baby's like tied to the tip and like looking behind them, you know, the whole time and like, you know, dysregulated, right. And the parents just like, I just can't make my baby latch. And you're like, oh my gosh. Like I just, yeah. Wanna help you. Help you like Yeah, it's a different kind of

Leah: helping and also like helping them see their baby and. Helping them understand the pieces, the big important pieces in the latch process that their baby's bringing to the table, and even in the, you know, milk-making process and all these things that, like their baby brings a big chunk of all of this to the table. I mean, I tell parents that all the time, like, you can really only bring about 50% to the table and your baby's gonna bring the other 50%. So we can't blame any of the problems on one party or the other. Because, you know, like, so putting all the blame on you is, like you said, it's like so sad, but also like it's so important for them to understand that it isn't all in their hands. Like there's a big part that the other partner in this relationship is gonna bring in. And both sides of that equation need to be evaluated and sorted out. So they can both bring the, you know, as much as they can to the table. But I do feel like. With so many professions because breastfeeding or lactation isn't fully understood, it's the one variable that seems, you know, could be an easy problem to say, well, it sounds like you know, that's the problem. So let's take that off the table and we'll solve all your problems. Versus like, wait, this is the physiologic norm. If this can't, you know, we've talked about that at every conference. I feel like we, I leave going like, this is a physiological norm. This is a vital sign. Like this should be the first thing that we're looking at for thriving and knowing that a human is healthy because they can produce milk, you know, like that their body is following the norms of end of pregnancy and these next stages. And like, if that's not happening, Why are we not investigating that? You know, and I think that's where our profession can really shed some light on that this isn't just like take it or leave it unless that's the parent's choice, but more like if it's not working, not just to be like, well, sorry it doesn't work, but like, hey, this is a sign that something else is amiss here and warrants and deserves further investigation, can't just be brushed off. And that's where I think we can help promote. Like families really understanding what might be further, you know, under these kind of surface layers of like a baby can't latch or like I can't get my milk production up is like, oh, okay, maybe there is something bigger. Maybe we need to dive deeper. And, and I've had that happen numerous times where we find out, oh wow, the parent, lactating parent actually has some hormonal issue or. Anemia or something that like, hey, if we would just say like, oh, sorry, some people just like can't make milk. Sorry about that. Let's move on. Like that person's gonna continue to suffer with something else. Where the symptom of not being able to produce is a sign that they need to be investigated deeper. And I feel like that's like a huge contribution that we can make on both sides of the parties, you know, with the infants and the parents.

Annie: Yeah. And sometimes it's about even just identifying where things went off the rails, you know, really trying to find out like how, like where's the place where I can say, this wasn't your fault. Right. You know, like things like, okay, like you're here at one month postpartum, you haven't been pumping, or you had a week, you know, you didn't pump for the first week for, you know, whatever reason that was. And now you've been pumping and you don't have a full, full milk supply. Finding the way to explain. That you know what's happening with her, you know, her body's response may be affected by that week where you weren't pumping in a way that does not put blame on her. So I'm always like trying to be very creative. Yeah. To be like, I mean like when in doubt, just throw the system under the bus. You know, you're really let down. These were circumstances outside of your control. You did what was right during the time when you did it. You know that's what your baby needs. You made the right decision. These are some of the effects of that decision, but you can't go back. You're not gonna go back and change what you did because you did that for a reason. Some way to say that, like I always, I'm like, it breaks my heart and I, you know, you get this feedback sometimes and like you never know, like, Contention versus impact. And I did have somebody, a client who we both, Karen and I have been working with her for a long time. Her baby's quite old now, but she was like scheduled an appointment with me and she's like, I just wanna tell you that there were some things. She's like, this doesn't take away anything from like, she's like, I think you explained things really well. I think you're really strong with your clinical knowledge. She said, but there was something that you said that really got in my head and really caused me a lot of anxiety and it was something that was a clinically correct thing to say, but it landed differently with her because of the state that she was in and so, You know, in that case I was like, well first of all, like I thanked her. I was like, thank you for being brave enough to share that with me. I really appreciate it. I take your feedback seriously. It's helpful for me to reflect on where the impact didn't match what I was trying to get across there. So, you know, you get that. Like I'm always, I'm probably always gonna get some, you never know like where something is gonna land based on their circumstances. I'm really trying to, Avoid saying things that can make it, make a parent feel like it's their personal responsibility to make it perfect.

Leah: Yeah, for sure. And I think, you know, it's a beautiful example of, I think families are really open with us because we spend time with them and we probably spend the most amount of time than any other provider on their healthcare team. Giving them that extra kind of slowed down attention and being able to connect with them on a level where we can spend some, some more time building that trust and then they feel comfortable telling us exactly how they're feeling, what's going on. But even stuff like that, like giving us feedback where I don't feel like when you have these short visits with a. You know, your medical provider, they spend five minutes or 10 minutes with you. Oftentimes, you're not gonna build enough trust or security in that relationship to feel like you could share like, Hey, when you told me that, you know, it was probably my fault that my baby wasn't doing X, Y, and Z, you know, or something like that. Like they wouldn't feel like they had the space or comfort level to communicate back with them. Or to even share how the things that those providers might be saying to them are making them feel or not feel or losing some confidence or trust in themselves. You know? And so I feel like probably one of the very high-level things that we contribute is this ability to have more time to build a little bit more of this clinical relationship that has a lot of. Trust in it, which opens up the possibility that we're going to see a lot of things that no other providers are seeing. Hear a lot of things that no providers are hearing, both about the families, but also about our care. You know? And I think it's just something very unique that, I don't know, a lot of providers understand the time spent and like what a difference that makes because they've never, I mean, like I doubt very seriously that many. You know, clinical providers, especially pediatricians and obs, have ever spent two hours with a family, a dyad. Like, yeah, I know like the most extreme situations ever, but like I can't imagine that that's ever happening and how much that changes your perspective, but also like what you can get out of the visit and everything, like how much more you can information and understanding of the situation that you can collect with that, that you just cannot collect and 10 or 15 minutes.

Annie: Our biggest like challenge when it comes to getting paid by insurance companies is about that particular issue. Like I would have no problems with insurance if I knew how to run a visit in 25 minutes. Like I would be, I'd be golden. I'd be, you know, seeing 10 people a day and getting paid for them. But I don't know how to do that and I don't really want to know how to do that. So working to get the insurance system is not really set up to recognize that kind of effort. And but also, you know, when you were talking, I was thinking about like the one thing that like I always get so sad when a family comes to me and they're like, well, they just said my baby is lazy. You get that lazy, like we need to like stop calling babies lazy. Never ever just stop. There is no lazy baby.

Leah: I know. Not on this planet That like the human race would not have gone on if babies were born lazy. Sometimes like babies are working as hard as they're capable of working and it is like I have such a. You know, soapbox moment whenever I hear that, cuz I'm like, your baby is doing the best it can. I always say that the human race would not survive if you know evolutionary. We just sometimes screamed lazy babies. Like that's not how it works. Like all babies are trying to survive and they're doing the best they can. There's always a reason that they appear lazy. But they're not innately lazy, you know? Yeah. I'm just like sleepy or, you know, whatever. There's always a reason.

Annie: Yeah. It's like, it's not physiologically possible for a baby to be lazy. Right. It's so hard. It's so rewarding, and then it's, it can be so frustrating when you don't have enough time or you know, insurance or finances get in the way and you can't really continue that relationship for whatever reason. I know like most of us are more generous when it comes to, you know, going beyond our boundaries, and doing more than what we're getting paid for because of that investment we have in the families. It does feel so satisfying when you see that parent and that baby, like have that moment together where you're like, Right now you're the only two people in the world. And whatever that looks like, whether they're bottle feeding, breastfeeding, using a supplement at the breast, just, you know, doing some baby massage or looking at each other, like whatever is happening in that moment, like getting to witness that and see that like, Never gets old.

Leah: Yeah. And it's why we keep going through, because like yes, we do all these things different, but they come with a heavy toll. And the heavy toll is like because we spend so much time, we do get our hearts and our minds invested in trying to support them as best we can. It's harder to detach from all of it when you are part of this person's. Stay for such a long period of time. It's like you really see all the ways that you could have a positive impact and you just, well, I don't know if I'm speaking for everybody, but definitely for myself, I just see like I could help so much and then, you know, you just become like, like you said, kind of like pushing a little bit, being more generous because you can see what an impact, like them understanding this or being able to do this or just like getting them to that place where they can have that really beautiful, peaceful moment and you know, From all of the work that we've done and all the outcome studies that have been done, like how impactful that is and like you're literally changing two people's lives when we can help families build this relationship, whatever that relationship needs to look like for them. And I feel like that makes it like a heavy toll on us. So even though we choose to do this really hard work in this really different way than any other healthcare professional, I feel like we walk into it. You've gotta like understand that like, this is gonna be a heavy toll and it's worth it. But it's also like all the podcasts we've done on like boundaries and self-care and like, you gotta, you gotta, you know, find a way to work through all those emotional pieces of it too. And I think it like, comes with. The pros are we can really do all these things that we've listed today in a different way, but it actually is so important that we recognize how that impacts being a healthcare provider in a different way. You know, like we've got a lot of different emotional toll and things on our backs that I feel like other healthcare providers, you can't get to attached to a situation if you only have 10 minutes with somebody. You can kind of stay in that like removed, attached state way more easily, you know? I can imagine. So. It's like comes with some, some, uh, some extra. Give and wait to the whole situation. But you and I know, and we've been doing it long enough that like in the end, it's worth it. And I think that our role is so powerful and has such a huge value for the healthcare team that I think it's worth it,

Annie: We're not the only ones that feel this way. We know that so many of you feel this way too because it comes up during our deeper dives in the conversations that we're having in the chat, the questions that are being asked of our guests. And this month our deeper dive is on counseling families about tongue tie, which is one of the most complicated clinical situations that we face. On a very frequent basis. Oh, so frequent. Yes. I mean, they're way more complicated clinical situations that you rarely see, but tongue tie's, like I feel like I just am dealing with this all the time. And our special guest this month is Melissa Cole, Ms. I B C L C, and you may know Melissa as an instructor, an herbalist, and she teaches about using herbs for milk supply, milk production. She also teaches about tongue tie, oral rehabilitation, and. Is an amazing wealth of knowledge on this topic, and we're so excited to have her come. But we're gonna be specifically focusing not on the clinical techniques around tongue tie or identifying tongue tie, but what does it look like to support a family who is dealing with a baby that has a tongue tie? And what that looks like and how it is different for different situations. And yeah, all of those deep pockets of clinical counseling skills that we need to have. I,

Leah: I am so excited about this because like you said, it's something that we face every day, but there's also like, just so much nuance to each individual case that I feel like, you know, I, I kind of have to chameleon to each situation so much that it really requires a lot of different skills and understanding because every family kind of has a different approach to how they want to deal with it, how they're feeling about it, and then a whole bunch of limitations because of our healthcare system around. Treatment and like all those aspects of things. I think it just requires us to pay a close attention because we do encounter this so often of like expanding our toolbox on helping those families from that counseling perspective. Cause I feel like it's an area where you really need to have like a lot of different tools because each time I encounter this, I feel like it kind of has this different evolution from it. Whether it's like the parents. Are really receptive or they're not receptive, or they're like, you know, the pediatrician says, no, there's not any problem. You know, or all those different nuances which require us to be like, okay, if this happens with this, then I know I can kind of share this information or talk about these concerns with them, or have them ask these open-ended questions, you know? So I just can't wait. I'm so excited about this and I think it's gonna be one of those talks that like, goes down in the history of like our deeper dies of like, This will be one I'll be coming back to and I know that we'll be really just such a wealth of knowledge shared, cuz Melissa is so awesome and she just has so many wonderful resources. But then she also has, you know, this ability to kind of show us the different ways that she has incorporated these wonderful counseling skills with, with us. I'm excited.

Annie: If you wanna join our deeper dive this month, it's happening on May 22nd at 2:00 PM Eastern, 11:00 AM Pacific. It is a Zoom with Melissa Cole. Everybody who signs up gets the recording. You can also sign up for a deeper dive subscription, which gets you enrollment in every live deeper dive that we host, plus access to our complete vaults of deeper dives going back to January 2020. You can sign up for that through the link in the show notes, or you can join us at Patreon and you will get these benefits. Plus if you're a member at a certain level for a certain amount of time, you'll, there's a little bit of swag that you can get to. So there's two ways that you can get involved on a regular basis or just show up for Melissa's. That's cool too. Whatever works for you. We just would love to have you there.

Leah: Yes, please join us live if at all possible. The live talks are so awesome and we really get so much value out of hearing everyone's questions and interactions and feedback. You know, yes, we have the guests, but we also get this wealth of all these other providers, other lactation consultants, and their feedback too. It's just such a great learning experience and it's not learning in a vacuum. It's learning with a whole bunch of people around you that can share what their perceptions are and what kind of what they're getting. Out of the talk too and, and hearing their questions cuz you're not alone, probably everybody else is thinking the same things. And we love getting to hear that and be like, oh, I wanted to ask that same question. I can't wait to see you in a couple weeks for Melissa's

Annie: talk. Yeah, I can't wait. And we will see you all there Until then, bye.