Do you like the visiting IBCLC? How about doulas?

[dahlialover]

Hello all,I am a birth doula and an IBCLC. I work in a small community and see many nurses and docs routinely. I personally always try to make a point of keeping a low profile at births, making sure my client does all the talking and decision making for themselves, and in general support the nursing staff both in front of them and behind their backs.

I try hard not to step on toes. Many nurses seem genuinely happy to see me ... BUT, it seems to be another story when it comes to me wearing my IBCLC hat. Although the warm aspects of my personality stay intact, I feel there is a switch that happens ( or doesn't happen) and I am seen as a "non contributer" of sorts. I am generally more informed about current and best practices in regards to breastfeeding and I have unfortunatly witnessed over and over unnecessary complications due to some nurses and doctors lack of up to date knowledge. It is extremely frustrating as I am left to try to peice back together the mess that has been made in the early days home for the new family.

I am wondering first: how do most of you see the doula and what are your main gripes and positives with her? Next: do you see the IBCLC as a professional that is very skilled in what she knows and do you openly seek out her expertise?

In my IBCLC education I understand that I can and should write out a care plan for famlies with challenges. If I ever did that at the hospital I am involved with and the staff saw it, I think they would just laugh! Fortunatley, the head nurse agrees with me, and told me that they are going for Baby Friendly, which I knew. Not a moment too soon it would seem! Can anyone help me out here? Thanks, and thanks for all the wonderful posts here, I learn so much reading them.

[beckyv]

I can't answer as a nurse, but as a Lactation Educator, childbirth educator and doula, I can certainly understand exactly what you are saying. I am in the metro Atlanta area, and even here we have the same issues at large hospitals between the in hospital IBCLC's, out of hospital IBCLC's and the info given by mother/baby nurses... I am not sure what the answer is, but I do wish we were all seen as knowledgeable and helpful. It only hurts the moms and babies that we can't all work together cohesively. There is SO much to know, and SO much new information about breastfeeding coming out all the time, it would be impossible for someone who doesn't specialize in it to keep up with it all. Have you thought about maybe doing some kind of training for the nurses / doctors in your area? Or having someone come in to possibly do that? I know my trainer for my lactation educator certificate (through CAPPA) does in house training at hospitals, just to give new info to nurses and doctors and has had some success with that :) Good luck! I'm interested to see what replies come in about this!

[Fyreflie]

I love love love my IBCLC! I'm labour exclusively now so don't really see her but at my last 2 jobs (one baby friendly and one working on it) we had great relationships with them!

Doulas....really depends on the person. With no regulating body or consistent training or standard of care mandated it's hard to tell what you'll find. I've had horrible doulas more often than wonderful ones unfortunately--from telling a mom ruptured with mec not to go to hospital and then arguing with the OB about it in triage , to weeping profusely when a pt needed a c/s (she had needed one herself and said she had become a doula to keep other women from the same "fate," to getting in the physical way of myself, the father and the OB during pushing and delivery. I think some doulas are in it for very personal reasons and allow that to color their advice and perspective and that's really hard to deal with.

I have had some amazing doulas as well--there are many out there!!--but I still hold my breath until I know what I'm dealing with. I love great support for my Moms and it definitely helps them to achieve their goals so it's always a great boon to get a knowledgeable, supportive and focused doula who does her job well and helps me to do mine! For the others, I wish there was a regulating body to report them to.

Hope that somewhat answers your question!

[beckyv]

Many doulas are certified by organizations that do have reporting agencies - we have to sign codes of conduct, and have guidelines to adhere to. You could always ask the doula if she is certified and by whom, if you found that they really need to be reported. CAPPA and DONA are two national organizations that train and certify doulas.

I think you are correct, there are many great doulas, and then ones who do have a personal reason for doing it, which can cloud judgement and make for uncomfortable situations... and it's unfortunate for the other doulas that are so good. I know for the clients I was with, when nurses are very busy with several patients, having someone who is just there to support the mom and family has been so helpful and comforting to them - especially first time moms who just have no idea what to expect. :)

[Fyreflie]

Do those organizations cover Canada? Last time I checked we didn't have a reporting agency but it's been a while so maybe one has started....

I'm always in favor of good support :) thankfully we are almost always 1:1 care in my current job so I spend a lot of time doing labour support, which I love!

I gotta say, a good doula who is an IBCLC would be a dream for the whole experience!

[Fyreflie]

No I still couldn't find a registering agency that actually has a reporting system in Canada. Boo.

[beckyv]

You can try this organization: DONA International – Contact Us They have a selection for filing a grievance about their certified doulas and it looks like they have people in Canada. But, that's just for people certified through them... And CAPPA | Home is CAPPA in Canada :) Again, just for doulas certified through them. Hope that helps a little!

[bagladyrn, RN]

Ifyou really want to be appreciated as a lactation expert I'd suggest volunteering to be "on call" to come in on some nights. That is when the staffing is shorter and most of the problems with breastfeeding seem to occur - mom is exhausted, crying, ready to give up on breastfeeding, all the "helpful" relatives and friends have gone home and with less staff it is difficult, if not impossible to spend an entire feeding in the room with the mom.

Many a night I would LOVE to be able to call someone and say "I've tried everything I know, please help". A consult 8 hours later is not going to fix it.

As for doulas who operate as you do - they are great to have around.

[TexasCourgette]

I try to be open to anyone the mom is comfortable with in the birthing process (from admission to discharge), regardless of what I may think/feel about them, because it's not really about me, or about what I think about whoever she has chosen to support her. Everyone wants a good birth. We're all on the same team.

I LOVE lactation consultants--I feel like there's so much I can learn from them, and I try to take advantage of that when they're on-unit, so that I can be a better resource to moms when the LC's aren't around. Their services aren't necessary with every mom, but then again, neither are mine--there are plenty of women, all over the world, who give birth without nurses. The only time I've ever felt "ruffled" or undercut by a LC is if they villianize me for not knowing the latest information, or for not doing things "their way"--but that's a matter of the individual, not the profession. The profession's awesome--someone's paid to know all about something my patient may find challenging, that I don't have all the answers to. Who doesn't love that? I absolutely seek out their expertise.

As for doulas--it really depends on the individual. I sometimes walk into a room, meeting a family for the first time, and I already feel like I'm being regarded suspiciously--like somehow it's a known fact that everyone wants a good birth except for me, and I somehow have an ulterior motive or secret motivation to force interventions (I don't--I really just want my patient to have an empowering, healthy birth!). I don't like walking into a room where my patient thinks I'm the enemy, and I don't like it when I see individuals--doula or not--actively contribute to that dynamic. But a good doula can really make a difference for some women. For my part, I try to walk into every delivery with no preconceptions, even if I'm familiar with the doula and know she'll make me feel villianized--me adding to the negativity won't help.

[Elvish, BSN, DNP, RN, NP]

What Baglady said. I work nights, and we have said over and over and over how much we'd love to have lactation work nights. We have bare bones staffing. No techs, no lactation and 4-5 couplets per nurse. If lactation would come hang with us on nights, they might have an inkling of what we're up against. Moms are overtired, babies want to nurse all night that second night, and there is no one but us to do everything...then we get told we're not supporting breastfeeding when we in reality we are doing all we can but don't have the time that's really necessary. Or they have a very hungry, dry, jaundiced baby that they're scared to supplement in any way because lactation told them not to.

I appreciate our LCs when there is a problem and they have time that I don't have to spend at the bedside for the entire course of a feeding. What I don't appreciate is when I have a hungry baby that has lost >10% of his birth weight, clearly dry and jaundiced, being raked over the coals for offering supplementation. I am an ardent exclusive breastfeeding supporter, both in and out of the hospital (breastfed two kids myself for 28 months and counting), but there are times when supplementation is indicated by the AABM. I don't appreciate being told I don't support breastfeeding when I suggest supplementation under those circumstances (and often with a physician order). That's why lactation gets the reputation for being the breastfeeding police. (For the record, I work with mostly wonderful LCs and there are only a couple bad apples that get under my skin.)

It is about the same with doulas - there are a few great ones, a few that are neither here nor there, and a few that irritate or overstep their bounds. For the most part, they are really great to have at the bedside because the nurses are mandated to do so much busywork to satisfy the bean-counters and it takes away from patient care.

[rn/writer, RN]

As a postpartum nurse, I don't have contact with doulas, but I do have lots of interaction with lactation consultants. I would like to reiterate the earlier thoughts that it would be really helpful to have some LC services on night shift. As far as breastfeeding goes, nighttime is definitely the weakest link. You have fewer staff members, fewer helpful partners and the hypnotic blanket of exhaustion in addition to all the regular challenges.

It would be wonderful to have something (someone!) to offer beyond the promise that the LC will see you sometime during the day. We all do the best we can, but I feel terrible when it's a busy night, and I just can't spend a half hour helping a wee one to latch.

I also agree that there are times when supplementation is the right choice. Neither I nor my co-workers appreciate the attitude that formula is somehow just a hair above insecticide for feeding a dry, yellow baby who has lost 10% or more of his birth weight.