Parents may well assume that all health workers giving advice on breastfeeding know what they are talking about; sadly this is simply not so. Mums are often left confused and unsure after receiving conflicting advice from a number of sources – some wrongly believing breastfeeding is something that only a small number of women can do and the only answer is to supplement or stop.

Before I start, I would like to say there are some amazing Health Visitors, Midwives and Doctors out there; passionate to support and inform breastfeeding mothers. That have undergone extensive training, perhaps compounded by breastfeeding themselves – but how does the new mum tell who they are, when at present this is NOT guaranteed?

Many new parents are surprised to hear that some Health Visitors may receive less than half a day’s instruction on infant nutrition. In addition she may not have breastfed her own baby, perhaps encountering some of the problems she is now expected to solve. Without further training, how can she hope to effectively manage this?

It’s no surprise therefore that instead of investigating breastfeeding technique, she may simply advise formula supplementation if weight gain is low. Health Visitors can request extra training if desired, but realistically many say they are already extremely stretched to fit existing duties in, therefore how many select this option when there is the easy and often widely accepted alternative of formula? It can also be quite an emotive subject for someone who has not breastfed their own child. Instead they may simply pay lip service to breastfeeding, undermining the process perhaps without even realising.

GPs have a long and comprehensive clinical training, but may have learned nothing about lactation management. They may therefore simply prescribe antibiotics for mastitis, not aware of the necessity to explore why mastitis may have occurred, or the mother’s greater need for help with positioning to ensure good milk drainage (Renfrew et al, 2000: 61) and help prevent recurrence.

Midwifery studies at least include various aspects of breastfeeding promotion; covering anatomy and physiology, public health and counselling skills. Clinical training alone however, may be insufficient for a midwife to recognise poor attachment to the breast, or to know how to help a ten-day-old breastfed baby with colic. Incorrect information may also be recycled from a newly qualified midwife’s mentor, and shorter hospital stays mean they don’t often ee the results of advice given. The nationwide shortage of midwives compounds the problem, and many feel very frustrated by the lack of available time for postnatal care.

Hospitals which have Baby Friendly Initiative Accredited units (BFI) have demonstrated their commitment to the “Ten Steps to Successful Breastfeeding” – one of which involves mandatory three day training for all health professionals involved in the care of a new mum (WHO, 1998)

But this course alone will not equip all Health Professionals to adequately help mums if there is a problem beyond the very basics – nor is it intended to be used as such. Whilst women are told often to breastfeed, the practical help on how to do so is often sadly lacking.

Unfortunately, given the UK’s breastfeeding rate and culture as a whole, many many mums will receive postnatal support from the latter group of health professionals. Given a new mum may know little or nothing herself, how can she be confident the information she is receiving is correct?

What now makes things even more complicated for mothers is the NHS have decided to invent some breastfeeding roles, to demonstrate they are trying to increase rates. Unfortunately, often the Trust doesn’t feel these supporters need to have any breastfeeding qualifications or experience. Instead, women with 8-12 weeks training are left providing antenatal education, visiting women in their homes and providing postnatal breastfeeding support if there is a problem. They often are unsure of their defined role and confused as to the boundaries of their remit.

Below is a genuine job advertisement I found April 2010. I have removed the name of the Trust because this problem is not isolated to any one area, but is Nationwide:

SALARY: £13,653 – £16,753 PRO RATA BAND 2
You will feel passionate about breastfeeding and early years nutrition to join the breastfeeding community peer support project. You will support woman mainly in their homes with breastfeeding management and be part of a team developed to improve breastfeeding rates within x. You may also be involved in ante-natal education and community engagement where required to raise awareness of breastfeeding and its key health outcomes for both woman and babies.

The very real danger is mums can believe they are obtaining support from someone qualified – when the suggestions don’t work (which they may well not) the mum gives up, believing if they can’t help then nobody can. A new mum can’t tell good information and support from bad, many of us couldn’t change a nappy before our baby landed a few days ago, let alone figure out why our baby still seems hungry or nipples are throbbing!

As someone who helps in the community, I can also confirm that sometimes incorrect advice can go beyond just not helping, and actually exacerbate the problem.

These health professionals then tell mums not to feel “guilty” if breastfeeding doesn’t work. Rather convenient, given that the new mum (who may know little or nothing) was dependent on the Health Professionals – realistically did she ever stand much of a chance? If someone has a terrible driving instructor, is it their fault if they struggle learning to drive?

Perhaps the mum will then try to seek specialist support, yet this in itself seems to be turning into a minefield! Met with a barrage of titles; peer supporters, breastfeeding counsellors, peer counsellors and breastfeeding supporters. In addition people may use titles they are not actually qualified to hold. One mum I met told me she was a breastfeeding counsellor – upon delving further I discovered she was actually a peer supporter (see below for differences). I have heard mums say they have seen a lactation consultant – upon further discussion this was actually a midwife rather than a certified lactation consultant.

At present only the voluntary breastfeeding support agencies have high standards of practical training built into their curricula. Lactation consultants have various pathways to certification by a rigorous, 6-hour examination. See below.

Titles and what they mean:

1. Peer Supporter: also called: Breastfeeding Peer Counsellor, Peer Counsellor, Peer Helpers, Mother Supporter, Breastfeeding Buddy, Healthcare Assistant.

These are mums who may or may not have breastfed their own baby (usually no criteria as to how long) and want to support other mums. Peer supporters by definition aim to protect and promote breastfeeding within their local area, relating to mums from a similar culture. They provide information which encourages mums to make educated decisions about their personal feeding choices and reach their goals. Peer supporters draw on their personal experience, combined with a course of up to 10 weeks long (depending on the organisation) which covers a wide range of topics from social and economic issues to anatomy, counselling skills and understanding baby’s needs from infancy to toddlerhood.

A peer supporter shouldn’t be offering problem solving or counselling; their role is to give you support as a ‘well informed friend’, and will be able to point you in the right direction if you need more specialist help. Most organisations are very clear that their supporters are not insured to solve problems and clearly define what is within the remit of these mums.

This is the main group the NHS is using to provide local breastfeeding support workers. Imagine going to the hospital with a broken arm and not seeing a specialist, but being referred to someone who broke their arm last year to deal with it! To read more about this click here.

2. Breastfeeding Counsellor: also called: La Leche League Leader, Breastfeeding Consultant, Breastfeeding Supporter. 

These are mums or health professionals who in addition to completing the above training have breastfed their own baby for at least 6-9 months at the point of application (depending upon organisation). This includes exclusively breastfeeding until there was a nutritional need for other foods (i.e., about the middle of the first year for the healthy, full-term baby).

Exact requirements vary from organisation to organisation but for example the LLL state if baby has weaned, it’s important the baby was nursed for about a year at least, and the transition from breastfeeding respected the baby’s needs.

A counsellor undergoes 2-3 years part time training, Many then continue to work in a voluntary capacity, both in local areas running support groups, manning national help lines, occasionally on the hospital ward or teaching peer supporters.

Training includes the following:
•Anatomy & Physiology
•Positioning & attachment
•Expressing & store of expressed breastmilk
•Breastfeeding and returning to work
•Why and how can employers support employed breastfeeding mothers
•Twins & multiple births
•Weaning & night feeding/weaning
•Introduction of solid foods
•Breastfeeding after Cesarean Section
•Ethics & confidentiality
•Counselling & listening skills including boundaries and reflective practice
•Leading a support group
•Premature babies
•Baby blues & PND
•Newborn behaviour and development
•Feeding patterns
•Crying, colic, reflux & sleep
•Medications & milk
•Problems e.g. anterior and posterior tongue tie/thick labial frenum, insufficient weight gain,
thrush, mastitis, nipple trauma, jaundice, high arched palate/bubble palate, inverted nipples,
constant feeding, unsettled infant, breastfed baby.
•Nutrition for the breastfeeding mother
•Special Circumstance eg Downs Syndrome, poor muscle tone etc
•Political and social issues surrounding breastfeeding
•Social & Environmental impact of breastfeeding
•Breastfeeding an older baby/infant & weaning
•Breastfed baby and allergies/intolerances
•Health impact of breastfeeding & risks of artificial feeding practices and milk.

3. Lactation Consultant: The term lactation consultant loosely refers to anyone who is working in the field of lactation, either as a volunteer or as a professional, but only the letters IBCLC after an individual’s name identifies that person with a recognized standard of independently measured competency in lactation.

A certified lactation consultant has met the strict criteria to apply for and passed, the examination set by the International Board of Lactation Consultants Examiners (IBLCE). “The IBLCE’s mission statement is to certify, by means of an internationally recognised examination, individuals who demonstrate their competence to practice as International Board Certified Lactation Consultants, providing quality care to babies and mothers world-wide” (ICLA 1995).

Periodic re-certification is mandated by the IBLCE thus ensuring continuing competence and up-to-date information. Only successful candidates may use the title ‘International Board Certified Lactation Consultant’.

Lactation consultants may be mothers who have trained as breastfeeding counsellors and served extensively as a counsellor or midwives/doctors who also have extensive experience supporting mothers – both must have undertaken further study.

Many IBCLC’s are employed in the field of clinical lactation, work in hospitals, providing training to others i.e. midwives and other supporters and breastfeeding preparation classes. They may also run support groups and or offer private practice to support mothers (sometimes for a fee, so always check)

If you need help in hospital, ask for their Infant Feeding Coordinator and then check they are an IBCLC (or well on the way) once in the community, check titles and remember anyone who is qualified will have the appropriate badge/certificate to show you – if in doubt ASK.