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Leaders and Lactation Consultants

from LEAVEN, Vol. 28 No. 5, September-October 1992, pp. 75-6
by Mary Renard
LLLI Board of Directors
Vienna, Virginia, USA

Dear LLLI,
I'm concerned about what seems to be a growing trend. On the US television program, "The Home Show," the mother of a five-month-old breastfeeding baby remarked that the LLL Leader she contacted for help referred her to a lactation consultant.

In five years of LLL leadership, I have never found myself in a situation that required me to go beyond my Area Professional Liaison Leader for information outside the realm of my personal experience or LLL written resources. If we in LLL consider ourselves to be the "world's foremost authority on breastfeeding," when, if ever, is it necessary or appropriate for Leaders to refer mothers elsewhere for information?

Betsy Liotus
Schaumburg, Illinois, USA

Dear LLLI,
Some comments made by a lactation consultant who is also a Leader have left me feeling unsure of my abilities to help breastfeeding mothers as a La Leche League Leader.

During a Chapter Meeting this Leader expressed concern over what she perceived as a lack of follow-up by LLL Leaders in the more complex problems of breastfeeding, e.g., slow-weight-gain babies and mastitis. She was talking about Leaders who do not make home visits when the mothers need to be seen, the delay in receiving appropriate LLL written information through the post, and Leaders' inconsistency in calling mothers back within a couple of days.

Another Leader also said that if we as LLL Leaders are not prepared to make follow-up calls, visit mothers who need to be seen, or invite mothers into our homes then we should not publish our telephone numbers on posters.

I need some help in sorting out what LLLI expects Leaders to do and what lactation consultants expect us to do as LLL Leaders in these situations.

Irene Deans-Dundas
Harare, Zimbabwe

Dear Betsy and Irene,

As Sally Tobin wrote in "Guidelines for Active Leaders Who Also Work as Paid Lactation Consultants" (May-June 1990 LEAVEN, pp. 39-41):

It is important to note that LLLI has no authority to define what lactation consultants can or cannot do in their lactation consultant role. It is, however, equally important to remember that only LLLI can define what the limits and expectations are of the active LLL Leader.

LLLI's expectations for Leaders are defined in THE NEW LEADER'S HANDBOOK. Leaders' basic responsibilities are listed on pp. 3-4, and LLLI's expectations concerning follow-up calls and home visits (which may take place in either the mother's or the Leader's home) are listed on pp. 32-33.

It is true that in some situations a mother and baby need to be seen. THE NEW LEADER'S HANDBOOK lists some situations that may require a home visit:

  • When a baby is refusing to breastfeed or having trouble latching on,
  • When a baby is not gaining well and the usual management suggestions are not helping,
  • When a mother has persistent sore nipples and over-the-phone suggestions have not helped,
  • When a mother needs a breastfeeding- aid product, such as a breast pump or nursing supplementer.

Home visits and "hands-on" help are within the scope of LLL leadership and are covered by Leader liability insurance, despite persistent rumors to the contrary. (The only exception is if a Leader is paid for her services. Only volunteer help is covered under LLL's insurance plan.)* But home visits are optional and are not considered part of a Leader's basic responsibilities. THE NEW LEADER'S HANDBOOK goes on to say:

  • If, due to family needs or other factors, a Leader decides not to make a home visit when it seems necessary, she has other options for making sure the mother gets the help she needs.
  • After consultation with another local Leader, the Leader may make arrangements to have the other Leader meet with the mother instead.
  • If the monthly meeting is being held soon enough, the Leader can make arrangements to have the mother come there for help.... The timing of the meeting is an important factor, since some problems need immediate attention.
  • If no Leader can make a home visit when it seems to be necessary, the Leader can refer the mother to a qualified lactation consultant if the Leader knows one in the area who would be able to help. In this case the mother should be advised that the lactation consultant will charge a fee for her service.

Sometimes Leaders (especially new Leaders) who are unsure of their helping skills may feel tempted to refer all mothers with complicated or unusual problems to other more experienced Leaders or lactation consultants. But sending these mothers elsewhere deprives a Leader of the opportunity to improve her skills. Helping mothers is how we learn and grow in self-confidence.

It is also important to keep in mind that every Leader (and lactation consultant), no matter how experienced she is, will at some time find herself confronted with a situation or problem for which she does not know the answer. At these times, a good place to begin is to consult THE BREASTFEEDING ANSWER BOOK, which was specifically designed to be used as a resource in these kinds of situations. LLLI also offers many other written and people resources for Leaders seeking informa- tion. See "Using LLL Resources to Get Medical Information" (July-August 1991 LEAVEN, pp. 51-54) and "When a Leader Doesn't Know the Answer" in THE NEW LEADER'S HANDBOOK, pp. 25-31.

If you have never made a home visit and would like to try but feel nervous or unsure of yourself, before you are faced with a mother needing immediate help, try to find another Leader who has done home visits. If there is no one in your vicinity, write or call your District Advisor and ask if she knows of a Leader you could contact. If a Leader who has done home visits lives near you, perhaps she would be willing to talk to you about her experience and offer suggestions--or even accompany you for moral support.

Elizabeth Hormann (Koln, Germany), Publications Administrator for the Around the World Division, writes:

As I read the letters about Leaders referring to lactation consultants, I detect more than a little defensiveness about the skills of LLL Leaders. It is a defensiveness that I don't think is necessary any more than a general practitioner needs to feel defensive about her skills in treating illness and helping her patients stay healthy. But there will be times in her practice when she will want a second opinion or will want to refer to someone who specializes in a particular area. We recognize this same principle in LLL when we go "up the chain" using the skills and varied resources available through our District Advisors, our Area Professional Liaison Leaders, LLLI, and the Health Advisory Council. It has always been clear that no Leader knows everything.

Keep in mind, too, that just as Leaders have different levels of helping skills, so do lactation consultants. As Julie Stock wrote:

Lactation consultants may be Leaders or non-Leaders with personal breastfeeding experience and high levels of knowledge or they may be health professionals who have never breastfed a baby but have been assigned to help breastfeeding mothers and are expected to acquire information and skills as part of their position. Some few women may simply proclaim themselves as lactation consultants with little or no breastfeeding experience and no background in the field of health care.

For this reason it is important to take the time to get to know a lactation consultant and learn more about her approach to helping mothers and handling breastfeeding problems before referring mothers to her. One way to do this would be to invite her to speak to local Leaders at a Chapter Meeting.

Kittie Frantz (Los Angeles, California, USA), pediatric nurse practitioner and retired LLL Leader, writes:

A true professional knows when she is in over her head and refers to an appropriate source of help that she has personally investigated previously. Having said this I see a lot of LLL Leaders feeling disempowered because "they don't possess a lot of technical knowledge." These Leaders refer [mothers] often to a lactation consultant, forgetting that LLL's gift is knowledgeable support and she does possess a skill to mother that mother. I would tell [a Leader] to give what she has and refer only if it isn't working or she feels truly out of her area of expertise.

Jimmie Stimpson (Greenboro, North Carolina, USA), Leader and lactation consultant, writes:

[Leaders in my area] consider the lactation consultant to be an additional resource [and] the lactation consultant's availability [to be] a positive alternative for everyone involved, particularly for situations involving repeated "hands-on" care. This situation exists because the Leaders and lactation consultants in our area have a mutual trust and respect for each other.

Cindy Smith (Anderson, Indiana, USA), US Western Division Professional Liaison Program Advisor, writes:

The majority of Leaders are capable of handling the majority of breastfeeding questions. Occasionally there will be situations that need a more immediate response than an individual Leader is able to comfortably provide. Since the health and well-being of the mother/baby dyad must always be our prime consideration, Leaders who find themselves in these situations are expected to offer mothers whatever choices are viable in her community: referral to another more experienced Leader or Professional Liaison Leader, referral to a community-based lactation consultant, or referral to a supportive health-care provider, if that is more appropriate. There can be no rules or guidelines for these referrals because every community and every situation is unique. Please remember that the choice of where to turn next should remain the mother's and that she should be informed about all possible alternatives.

Chele Marmet (Los Angeles, California, USA), Professional Liaison Leader, International Lactation Consultant Association Board Member, Coordinator, UCLA Clinical Lactation Consultant Program, Director, Lactation Institute, writes:

When a Leader receives a mother's call, she can do everything within her resources to help the mother. If, however, there has been little or no improvement, she can refer the mother and baby to someone with clinical skills, knowledge and [if the referral is to a lactation consultant] (preferably) IBCLC certification. When referring, the mother should be given choices. This empowers the mother to control the outcome of her situation, and she becomes stronger as a result. A referral should be followed up by the LLL Leader to see how things are going. Once the problem is resolved, the lactation consultant would [ideally] refer the mother back to LLL for ongoing support and education, which is what Leaders are trained superbly to do.

Leaders have much to offer breastfeeding mothers in both normal and unusual situations. As Julie Stock wrote in "Leaders ARE Lactation Consultants":

In the field of breastfeeding management and lactation information, there is room for both LLL Leaders and lactation consultants. Both offer services that would be greatly missed if one or the other were removed from the community In our effort to understand the role of the lactation consultant, it is vital that we not diminish or misinterpret the role of the LLL Leader... The La Leche League Leader gives our society an invaluable gift--one that is only hers to give.

*LLLI Affiliates--Canada, Canada Francais, Deutschland, Great Britain, New Zealand, and Switzerland--have their own insurance where needed and Leaders in these affiliated countries who are concerned about their insurance coverage should contact the organization in their country for information.

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