Teaching the importance of breastfeeding in a nutrition rehabilitation clinic in Madhya Pradesh, India

A lactation consultant is a health professional who specializes in the clinical management of breastfeeding. The International Board of Lactation Consultant Examiners (IBLCE) certifies lactation consultants who meet its criteria and have passed its exam.[1]

Description

Lactation consultants are trained to assist parents in preventing and solving breastfeeding difficulties[2] such as sore nipples and low milk supply. They commonly work in hospitals, physician or midwife practices, public health programs, and private practice. In the United States, lactation consultants are often nurses, midwives, nurse practitioners, and dieticians who have obtained additional certification.[2]

History and organization

The IBLCE was founded by a group of La Leche League leaders who wanted to professionalize the skills they had developed while working with breastfeeding individuals.[3][2] Candidates can choose various pathways to qualify, including options for current health professionals and volunteers, through college or university academic programs, or through mentoring. [4]

An International Board Certified Lactation Consultant (IBCLC) may use the post nominals IBCLC and/or RLC after their name. The International Lactation Consultant Association (ILCA) is the professional association for lactation consultants.[5]

IBCLCs undergo specialized training to assist families with breastfeeding, milk production issues, and pump management issues. IBCLCs must meet certification requirements for education and clinical experience, and pass an examination. IBCLCs must also re-certify every five years with 75 continuing education hours every five years or take an examination.[6]

Outcomes

Exclusive and partial breastfeeding are more common among individuals who gave birth in IBCLC-equipped hospitals.[7] In maternity hospitals, a ratio of one IBCLC for every 15 postpartum individuals is suggested.[8] The U.S. Surgeon General recommends that all communities ensure access to services provided by IBCLCs.[9] Evidence found that breastfeeding interventions including lactation consultants and counselors increased the number of individuals initiating breastfeeding.[10]

LGBTQ+ Care

Lactation consultants can be vital to helping LGBTQ+ parents navigate chestfeeding – the gender-neutral term for breastfeeding. Many lactation consultants are super inclusive and provide safe and educational spaces for LGBTQ+ couples, but some lack the empathy and nuance needed to care for this community.

Improvement in Inclusive language

Lactation consultants can improve their care of LGBTQ+ patients by using gender-neutral language such as “chestfeeding,” “parent,” and “parental” instead of “breastfeeding,” “mum,” and “maternity.” [11] By using gender-neutral language and by properly identifying patients using their correct pronouns – instead of relying on assumptions –, lactation consultants can actually affirm a patient’s gender thereby alleviating distress that companies gender dysphoria. [11]

Improvement for transgender patients

For some transgender and nonbinary individuals who may have undergone chest or top surgery, or experienced feelings of dysphoria in their own body at some point, lactation can reignite feelings of a sense of gender discomfort in their own body. For many transgender women, lactation can be gender-affirming, but for some transgender men, going through the process of lactating can bring up challenging emotions. Because of the variety of experiences that transgender people can experience during lactation, lactation consultants may understand that the process can look ‘non-traditional’ and have a multitude of emotional responses, often specific to unique transgender experiences. [12]

Specifically for trans-masculine patients, alerting those who receive top surgery prior to pregnancy that their chest tissue may grow and change throughout pregnancy and chestfeeding is something medical professionals rarely do. To cultivate an inclusive and educational environment for trans-masculine patients, Lactation consultants could better educate their patients about their bodies' inevitable transformation during pregnancy and chestfeeding prior to going through this journey. Lactation consultants can also help trans-masculine parents by asking for consent before touching their chests during medical exams. Many trans-masculine patients have reported that touching this private area can potentially trigger feelings of gender dysphoria and that by simply asking first, lactation consultants could greatly improve the mental health of their patients. There are many more improvements lactation consultants can make to how they care for their LGBTQ+ patients to create a more inclusive, welcoming, and safe environment. [11]

Inclusivity in these spaces, aversives such as othering, misgendering by a healthcare provider, discrimination, etc. can lead to future changes in behavior. Examples of these changes include changes in seeking medical care, success with lactation, stress levels, mental health, and an overall feeling of inclusion.

Some other steps healthcare providers and lactation consultants can take to ensure that transgender individuals feel comfortable receiving medical care are using gender-inclusive language, participating in effective training regarding trans health, and displaying inclusive signage on their websites and clinical spaces to indicate that they welcome gender-diverse populations.

Impacts of discrimination on the LGBTQ+ community

Transgender people often face misgendering and discrimination perpetrated by their healthcare providers. This can cause them to associate receiving healthcare as a negative experience which often leads to them avoiding or delaying receiving health care. According to a study titled Lactation Care for Transgender and Non-Binary Patients: Empowering Clients and Avoiding Aversives, “Since misgendering and discrimination have been widely reported by TGNB patients to be highly stressful, they may negatively affect milk production and feeding…” [12]

Impact of affirming LGBTQ+ care

One important part of lactation care is that of transgender individuals. There have been multiple case studies where trans individuals have received lactation care while also going through hormone therapy. In a case study, a transgender man started hormone therapy 13 months postpartum [13]. He was still chestfeeding his infant when the treatment began. The study tested the levels of testosterone in his milk and his baby. The study found no negative effects on the infant’s development or the infant’s feeding behaviors. In another study, a transgender woman was given lactation treatment so that she could chestfeed her infant. [14]

See also

References

  1. ↑ "IBLCE". Iblce.org. Retrieved 15 January 2018.
  2. 1 2 3 Lawrence 2016, p. 749.
  3. ↑ "LLLI - The LLL Leader and the IBCLC - A Partnership in Breastfeeding History". www.llli.org. Retrieved 19 January 2018.
  4. ↑ "IBLCE Continuing Education Review / Application Information". Iblce.org. Archived from the original on 6 February 2015. Retrieved 15 January 2018.
  5. ↑ "ILCA Home". Ilca.org. Retrieved 15 January 2018.
  6. ↑ "IBLCE". IBLCE. Retrieved 2021-03-05.
  7. ↑ "US Surgeon General Breastfeeding Executive Summary" (PDF). surgeongeneral.gov. Archived (PDF) from the original on 13 May 2017. Retrieved 6 September 2017.
  8. ↑ Lawrence 2016, p. 246.
  9. ↑ Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US) (2011). Actions to Improve Breastfeeding. Office of the Surgeon General (US).
  10. ↑ Patel, Sanjay; Patel, Shveta (August 2016). "The Effectiveness of Lactation Consultants and Lactation Counselors on Breastfeeding Outcomes". Journal of Human Lactation. 32 (3): 530–541. doi:10.1177/0890334415618668. ISSN 1552-5732. PMID 26644419. S2CID 26056972.
  11. 1 2 3 MacDonald, Trevor; Noel-Weiss, Joy; West, Diana; Walks, Michelle; Biener, MaryLynne; Kibbe, Alanna; Myler, Elizabeth (2016-05-16). "Transmasculine individuals' experiences with lactation, chestfeeding, and gender identity: a qualitative study". BMC Pregnancy and Childbirth. 16 (1): 106. doi:10.1186/s12884-016-0907-y. ISSN 1471-2393. PMC 4867534. PMID 27183978.
  12. 1 2 MacDonald, Trevor Kirczenow (June 2019). "Lactation Care for Transgender and Non-Binary Patients: Empowering Clients and Avoiding Aversives". Journal of Human Lactation. 35 (2): 223–226. doi:10.1177/0890334419830989. ISSN 0890-3344.
  13. ↑ Oberhelman-Eaton, Sara (7 September 2021). "Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man". Journal of Human Lactation. 38 (2): 339–343. doi:10.1177/0890334421103764 (inactive 2023-12-04).{{cite journal}}: CS1 maint: DOI inactive as of December 2023 (link)
  14. ↑ Reisman, Tamar; Goldstein, Zil (December 2018). "Case Report: Induced Lactation in a Transgender Woman". Transgender Health. 3 (1): 24–26. doi:10.1089/trgh.2017.0044. ISSN 2688-4887. PMC 5779241. PMID 29372185.

Cited works

  • Lawrence, Ruth (2016). Breastfeeding : a guide for the medical profession, 8th edition. Philadelphia, PA: Elsevier. ISBN 978-0-323-35776-0.
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