Booby Traps Series: Did your hospital provide enough access to an IBCLC?

This is the 38th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

It’s a common complaint I hear:  “I really needed help.  I asked to see a lactation consultant, but she never came.”

Not all breastfeeding problems require someone with the training and skills of an International Board Certified Lactation Consultant (IBCLC), but many do.  And research has demonstrated that having the assistance of one makes a big difference in moms’ ability to meet their breastfeeding goals.

So why do so many moms say that they waited in vain for the breastfeeding cavalry to arrive?

In 2010 the United States Lactation Consultants Association (USLCA) released guidelines for lactation consultant staffing in different hospital settings, based on some earlier research on optimal staffing ratios.  It recommended that for standard inpatient care (Level I facility), 1.3 lactation consultant positions (full time equivalent) are required for every 1,000 births per year.  For hospitals with higher level NICUs, the recommended rate his higher:  1.6 lactation consultants per 1,000 births in a Level II hospital and 1.9 FTE in a Level III hospital.

The USLCA cites a paper suggesting that 71% of mothers require the assistance of an IBCLC, and notes that the role of the lactation consultant goes beyond mother/baby care to include fostering a “social environment that effectively supports the breastfeeding mother/infant dyad.”

So how does that optimal staffing level compare with reality?

Survey data collected by the United States Lactation Consultants Association indicates that instead of the recommended 1.3 lactation consultant per 1,000 deliveries staffing level, the current ratio is 1 per 1,340 deliveries.  They also found that many hospitals don’t provide holiday coverage.  That may explain why moms report asking for, but not getting to see, a lactation consultant.

There is evidence of wide variation as well.  The Centers for Disease Control reports that the number of IBCLCs per 1,000 births by state ranged from 1.01 in Nevada to 11.13 in Vermont in 2011.  Not all of the IBCLCs they tallied work in hospitals, but the numbers do convey a sense of the range.

In Philadelphia, only half of the birth hospitals employed an IBCLC in 2009.  In contrast, Massachusetts’ perinatal regulations require every hospital, at a minimum, to “provide every mother and infant requiring advanced lactation support with ongoing consultation during the hospital stay from an International Board Certified Lactation Consultant or an individual with equivalent training and experience.”

Until the optimal staffing level becomes reality, we want to remind you that feedback matters.  If you were unsatisfied with your access to IBCLCs at your hospital, (or any other part of your breastfeeding care) write to your hospital.  Ask why you were not provided with the level of care you needed from someone with expertise in supporting moms in your situation, and explain the impact it had on your breastfeeding experience.  This kind of feedback is taken very seriously.  Your letter may make a difference for many moms who each year wait and pray for the cavalry to come.

Did you have trouble getting to see an IBCLC?  What impact did it have on your breastfeeding experience?

3 thoughts on “Booby Traps Series: Did your hospital provide enough access to an IBCLC?

  1. My first child was the only one born in a hospital. I’ve had 3 homebirths since. However, that first child was the one I needed the most breastfeeding help with! She was born on a Saturday and there was no Lactation Consultant on duty until Monday. I kept asking the nurses for help, but they were not familiar with breastfeeding and just wanted to give a bottle. I expressed cc’s of clear colostrum into a small medicine cup and cup fed her. I even resorted to giving her tiny bits of glucose water just to try to hold her off until we could get breastfeeding help. Had I not been so determined, we would have not made it. Finally on Monday we got help. By that point, the nurses had talked me into allowing them to give her a bottle of formula. That is the only bottle of formula any of my 4 children have ever had!


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