© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONChapter 1 The ©Lactation Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Consultant:NOT FOR SALE OR Roles DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION Elizabeth C. Brooks © JonesResponsibilities & Bartlett Learning, LLC © Jones & CatherineBartlett WatsonLearning, Genna LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALERebecca OR Mannel DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEA OR lactation DISTRIBUTION consultant (LC) is a specialist trainedNOT to FORConsultant SALE Association OR DISTRIBUTION (ILCA), which publishes focus on the needs and concerns of the breastfeeding the peer-reviewed Journal of Human Lactation and mother–baby pair and to prevent, recognize, and other documents relating to lactation consultant solve breastfeeding difficulties. LC services do not education and practice. In 1994, the Academy of replace those ©of Jonesother healthcare & Bartlett workers; Learning, instead, LLCBreastfeeding Medicine, an© international Jones & Bartlettphysician Learning, LLC the LC is an NOTextender FOR of maternal–childSALE OR DISTRIBUTION services. organization, was formed. ItsNOT official FOR journal, SALEBreast- OR DISTRIBUTION Lactation consultants work with the public in many feeding Medicine, also publishes peer-reviewed articles settings: hospitals, clinics, private medical prac- and helpful clinical protocols. In addition, La Leche tices, community health departments, home health League International and the Australian Breastfeed- agencies, and private practices. Almost all lacta- ing Association publish professional materials that © Jonestion specialists & Bartlett are women; Learning, many have LLC educational teach and© support Jones the & LC Bartlett as well asLearning, patient/family LLC NOTand FOR clinical SALE backgrounds OR DISTRIBUTION in the health professions information.NOT This FOR chapter SALE traces OR the DISTRIBUTIONhistorical roots or mother-to-mother support. Many are registered of lactation professionals and discusses work-related nurses, although physicians, dietitians, speech ther- issues. apists, and other health professionals practice as lac- © Jones & Bartletttation Learning, specialists as LLC well. A growing interest in ©the Jones History & Bartlett Learning, LLC NOT FOR SALEprofession OR DISTRIBUTION is also attracting many candidates whoNOT FOR SALE OR DISTRIBUTION study and work to enter directly into the lactation In a cultural setting in which nearly all moth- consulting field. ers breastfed, help with breastfeeding was avail- Lactation consulting is a rapidly growing health- able through the shared knowledge of other family care specialty. Prior to recognition of the LC as a paid members, neighbors, and friends. As childbirth specialist in 1985,© Jones individuals & Bartlett serving Learning, breastfeed- LLCcame to be managed by ©health Jones professionals & Bartlett in Learning, LLC ing women didNOT so as FOR volunteers SALE or asOR unrecognized DISTRIBUTION hospital settings and formula-feedingNOT FOR becameSALE theOR DISTRIBUTION practitioners. Over time, the lack of standardiza- cultural norm, however, knowledge of lactation— tion of skills and minimal competencies prompted which a mother formerly shared with her daughters formal development of the specialty practice. This or a sister with her younger siblings—was set aside © Jonesoccurred & in Bartlett part through Learning, a certification LLC examination or even lost.© Jones & Bartlett Learning, LLC NOTadministered FOR SALE by theOR International DISTRIBUTION Board of Lacta- Thus, NOTduring FOR the 1960s SALE (at ORthe nadirDISTRIBUTION of breast- tion Consultant Examiners (IBLCE), and through feeding) in the United States and shortly there- the establishment of the International Lactation after in other countries (such as Australia and © Jones & Bartlett Learning, LLC © Jones3 & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781449697280_CH01.indd 3 5/20/2014 9:40:06 PM © Jones & Bartlett4 Chapter Learning, 1: The LLC Lactation Consultant:© Roles Jones and & ResponsibilitiesBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Scandinavia), volunteer mother-to-mother breast- make a difference in breastfeeding outcomes? Ran- feeding support groups became a major source of domized controlled trials of breastfeeding interven- assistance and information© Jones about & Bartlett how to Learning,breast- tions LLC worldwide, most of which© wereJones conducted & Bartlett in Learning, LLC feed (Phillips, 1990).NOT As FOR the number SALE of ORbreastfeed DISTRIBUTION- developed countries, that were NOTpublished FOR in aSALE meta- OR DISTRIBUTION ing mothers increased, healthcare providers at first analysis commissioned by the U.S. Preventive Ser- ignored these groups; later they came to appreciate vices Task Force (USPSTF) can be accessed at http:// them for the important role they played in help- www.uspreventiveservicestaskforce.org/uspstf08 ing mothers and in forcing the medical profession /breastfeeding/brfdartfig3txt.htm (USPSTF, 2008). to© consider Jones lactation & Bartlett as a missingLearning, piece LLCof prenatal In the meta-analysis,© Jones breastfeeding& Bartlett Learning,promotion LLC andNOT postpartum FOR SALE care. OR DISTRIBUTION interventions NOTsignificantly FOR SALE increased OR bothDISTRIBUTION short- As these volunteers promoted the art of breast- and long-term exclusive breastfeeding rates. In a feeding, they also sought more knowledge of the subgroup analysis, combining prenatal and post- science of lactation. La Leche League responded by partum interventions had a greater effect on these © Jones & Bartlettproviding Learning, research information LLC to its group lead- © Jonesrates, and & includingBartlett some Learning, form of layLLC or peer sup- NOT FOR SALEers, who OR serveDISTRIBUTION as mother-to-mother helpers, and NOTport FOR increased SALE breastfeeding OR DISTRIBUTION rates even more. by publishing a quarterly newsletter, Breastfeeding In addition to this meta-analysis, a Cochrane Abstracts, which focuses exclusively on the scientific review—the “gold standard” of medical research— literature. Through La Leche League’s professional studied the effect of any extra support given to liaison department, key individuals sought to cul- breastfeeding women. Lay and professional support tivate and maintain© communicationJones & Bartlett links to Learning, health together LLC extended duration of ©breastfeeding, Jones & Bartlett espe- Learning, LLC providers in local NOTcommunities. FOR SALE OR DISTRIBUTIONcially that of exclusive breastfeedingNOT (BrittonFOR SALE et al., OR DISTRIBUTION Out of this context, some experienced breastfeed- 2007). Face-to-face counseling (Figure 1-1) is the ing support group members began to look beyond most effective intervention in increasing not only what they could accomplish as volunteers. Many of exclusive breastfeeding rates but also the total dura- these© Jones women & sought Bartlett to apply Learning, in a paid work LLC setting tion of breastfeeding© Jones (Albernaz & Bartlett et al., 2003; Learning, Andaya LLC what they had learned from many years of helping et al., 2012; Witt et al., 2012). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION breastfeeding mothers. In 1982, La Leche League If the data from the randomized controlled tri- formed its Lactation Consultant Department. From als included in the meta-analysis and Cochrane this beginning grew the concept of the need for a review were translated to healthcare costs saved by new healthcare worker, and in 1985 the indepen- © Jones & Bartlettdent certification Learning, board, LLC IBLCE, was formed. Shortly © Jones & Bartlett Learning, LLC Figure 1-1 Early Assistance NOT FOR SALEthereafter, OR DISTRIBUTIONthe Journal of Human Lactation (JHL) NOT FOR SALE OR DISTRIBUTION began. Edited by Kathleen Auerbach from 1985 to Promotes Confidence. 1996, by Jane Heinig from 1996 to 2012, and cur- rently by Anne Merewood, JHL is peer reviewed, professionally published, and cited on international indices with a competitive© Jones Impact & Bartlett Factor score Learning, (Bai- LLC © Jones & Bartlett Learning, LLC ley, 2005; Journal ofNOT Human FOR Lactation SALE, 2013). OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Do Lactation Consultants Make a Difference? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC InNOT this FORday ofSALE cost containmentOR DISTRIBUTION in health care, NOT FOR SALE OR DISTRIBUTION administrators want to know if lactation consul- tants are effective. Put simply, do interventions by lactation specialists and other healthcare providers © United States Breastfeeding Committee © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781449697280_CH01.indd 4 5/20/2014 9:40:06 PM © Jones & Bartlett Learning, LLC Certification: International© Jones Board & Bartlettof Lactation Learning, Consultant LLC Examiners 5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION breastfeeding, the result would show that lacta- Scott and Smith assembled a small group of tion services save the healthcare system enormous breastfeeding experts who had come to the field