By Cathy Heinz, Virginia, USA and Mary Francell, Georgia, USA
As La Leche League Leaders, we are accredited by LLLI to support families through the normal course of breastfeeding from birth through weaning (and sometimes beyond!). We have an important role in the breastfeeding landscape: supporting, informing, educating, and listening to families during this magical and sometimes challenging time of their lives.
There are times when breastfeeding is not so simple and families need specialized, “hands on” medical care from a lactation professional, such as a physician who trained in breastfeeding medicine or an International Board Certified Lactation Consultant (IBCLC). When a family needs help that goes beyond supporting, informing, educating, or listening, it is time to refer them to someone who can dig deeper into the potential causes of the issues and hopefully bring the family’s situation back to the normal course of breastfeeding. Leaders are generally devoted to helping others and may feel they “should” take on time-consuming and complicated cases if the lines between volunteer breastfeeding counselor and breastfeeding health care provider are not clearly drawn.
A distinction in roles
La Leche League International has long recognized this difference in roles. In 1982, the LLLI Board of Directors provided financial support and personnel to establish a lactation consultant program, which became the International Board of Lactation Consultant Examiners (IBLCE), the body that accredits IBCLCs. When applying to take the exam, LLL Leaders can use their volunteer experience as lactation-specific clinical practice hours, one of several requirements involved in the move from volunteer breastfeeding counselor to professional lactation consultant.
Sometimes Leaders feel confident that a baby or mother should be evaluated for a medical condition. In this type of situation, it is appropriate to provide information for a family to discuss with their health care provider, but Leaders must be careful to maintain the support/information/education role and not cross the line into diagnosis. For example, if a Leader suspects an issue like tongue tie or insufficient glandular tissue, it is important to not only share information, but also to allow the family to decide what to do with it. Whether you have been a Leader for five minutes or more than five years or fifteen, your role as a Leader remains the same. The families we serve may not fully understand the difference between community volunteer breastfeeding counselors like LLL Leaders and medical professionals like IBCLCs. This is why providing information/education and not diagnosis is so crucial in these situations. This protects the reputation of La Leche League International, since all Leaders are seen as equally capable of helping parents deal with situations encountered during the normal course of breastfeeding.
Worldwide, Leaders all receive similar education from their supporting Leaders and the Leader Accreditation Department. This base knowledge provides consistency for families to know that if they call on any LLL Leader they can expect a similar proficiency no matter where they live. Providing care that is beyond the Leader role not only involves risk of liability, but has the potential to imply to families that the same level of assistance would be available everywhere. Clear role separation prevents this possible issue.
For example, a parent may ask an LLL Leader to look inside her baby’s mouth to check for a tongue- or lip-tie. While this may seem like a simple request, observation alone is insufficient to determine the types of restriction that can affect breastfeeding. IBLCE-accredited lactation consultants perform oral assessments based on both appearance and function, using a gloved finger to feel subtle variations in tongue and jaw movement. A Leader who uses her finger to check a baby’s mouth should carefully consider her liability and other possible ramifications, including passing an infection to the child. In addition, even those Leaders who have done extensive research in this area should be careful not to overstate their ability to recognize tongue restriction, and they should always suggest these parents consult their health care provider for evaluation.
Many Leaders are also concerned about recommending the use of breastfeeding products. Products are defined as anything the baby was not born clutching in his or her tiny fist: nipple shields, baby scales, at-breast supplementers, devices to evert nipples, or the like. While products can often help save a breastfeeding relationship, they can easily cause harm if used incorrectly or without proper guidance. What if the product is not the right one or the baby has an underlying condition that is contributing to breastfeeding difficulties? Often, medical issues that affect the nursing relationship can only be ferreted out with an involved medical history that goes beyond the Leader-nursing parent relationship. In addition, if there is a problem with the device itself due to a manufacturing defect or damage during storage, the liability rests with the Leader for any product not sold by LLLI or the Leader’s Direct Connect Area Network (DCAN). Because of this, Leaders are encouraged to avoid providing or using breastfeeding products while working with a family. Leaders are free to inform families about what products exist, their proper use, and possible pros and cons, but the family decides if that product is appropriate in consultation with their health care provider.
When to suggest other resources
If the issues a family faces are beyond a volunteer counselor’s role, assisting with latch, or providing information or resources, the best course of action is to suggest the family consult a provider who can assist with assessments and breastfeeding products that may help maintain the nursing relationship. One reason this is so important is that the liability insurance held by La Leche League International only covers Leaders in the volunteer roles of mother-to-mother support and education. Leaving the boundaries of that role could put La Leche League at risk of litigation or cause public confusion about La Leche League’s place in the breastfeeding support landscape. Medical providers deal with pathology. Leaders work with the normal course of breastfeeding, which covers the vast majority of challenging breastfeeding situations.
Be prepared to know the types of possible providers for referral when a family needs more help than you are able to offer. IBCLCs can be found by searching a global directory such as the International Lactation Consultant Association’s ‘Find An IBCLC’ directory at http://www.ilca.org/why-ibclc/falc or http://breastfeeding.support/directory/. Alternatively find the IBCLC directory for your Area/Area Network such as United States Lactation Consultant Association (USLCA), Lactation Consultants of Great Britain (LCGB), or Lactation Consultants of Australia and New Zealand.
Here are a few other resources that may be helpful in clarifying the role of a Leader:
- A document highlighting the differences between an LLL Leader and an IBCLC is available on the LLLI website by clicking on “Become a Leader” in the upper right column, then on “Thoughts about Becoming an LLL Leader and an IBCLC.”
- Use of baby scales for test weighing: Is Weighing Baby to Measure Milk Intake a Good Idea?
- Information on tongue tie: Tongue-Tie and Breastfeeding
- LLL USA Policy: LLL USA policy on keeping roles separate
Resources vary by country, so part of a Leader’s training includes learning about local resources available to families. In addition, your DCAN may have their own set of guidelines to follow, or may work on a case-by-case basis as concerns arise. Contact your support Area Administrators for additional information on this subject. If your DCAN has a policy in place, use that policy as your guide.
La Leche League Leaders have been helping families around the world breastfeed their babies for almost 60 years. LLLI originated peer-to-peer lactation support, a proven strategy for improving breastfeeding outcomes that has been recognized and copied by many other organizations. LLL Leaders provide help that touches hearts and lives every day, all over the world. IBCLCs and other health care providers complement the invaluable roles offered by volunteer community breastfeeding counselors. We all have our place in the breastfeeding support landscape.
1 International Board of Lactation Consultant Examiners