I’ve been thinking about this for a long time, and I need to get this off of my chest. I’ve written a little bit previously about some of the issues moms face in getting competent breastfeeding help, but after having this conversation with many providers recently, I think it’s time to have a little bit of a discussion about the state of lactation support in Minnesota.
So, first of all, the advice that ONLY IBCLCs are qualified to help moms with lactation issues is ludicrous. When we’re talking about something that about 90% of moms start doing right after giving birth, there’s no need for stupid turf wars. There are a number of breastfeeding trainings and certifications, some with more rigorous standards than others, but just as Minnesota doesn’t mandate one specific type of training or certification for midwives who want to attend homebirths, a rational breastfeeding supporter would acknowledge that there are a few different ways that professionals can gain the information that they need to help moms figure out how to make breastfeeding work. Even the CDC, when they issue their annual breastfeeding report card, reports not only how many IBCLCs there are in a state, but also how many CLCs there are.
Second, it’s time to acknowledge that hospitals don’t have enough inpatient resources to help every mom get breastfeeding well established before being discharged. Although I don’t have any hard evidence to prove this, but anecdotally I’ve heard from families who gave birth in Baby-Friendly hospitals got absolutely no one-on-one support, perhaps because the dedicated lactation staff was either reduced or eliminated completely. Sometimes administrators think that by paying for 20 hours of trainings for all of the nursing staff, they need to recoup that money by getting rid of the experts. Or something. Whatever it is, the access to help is not improving.
Third, once moms get discharged, finding outpatient help can be nearly impossible. One health system makes everyone in their system go to one clinic in St. Paul, which may or may not have more than one IBCLC on staff. Visits from a public health nurse can help, but visits are not universally done, and not all nurses have the time to properly assist moms with breastfeeding. Many outpatient clinics report waiting lists of up to a week. And while there are LCs in private practice, most of them require moms to pay out of pocket upwards of $200 per visit, despite the fact that the Affordable Care Act mandates that insurers cover breastfeeding help at 100%. Now, there are some barriers to becoming an in-network provider, but those hurdles can be overcome. The larger issue is getting providers to understand reality versus the whispered lies and half-truths about insurance reimbursement they’ve heard in the past.
My point? Fixing our broken breastfeeding system in Minnesota is going to require that the IBCLC turf war goes away. It’s going to require that hospitals hire more lactation staff. Private practice lactation specialists need to to think outside the box (rather than only trying to build one box) to make sure families don’t have to pay out of pocket for services they shouldn’t be asked to pay for. After all, for every mother that gives up on breastfeeding sooner than desired, I’ll show you a mom who had little or no competent support. That’s just not fair to moms or babies. They deserve better.
Two things we’re doing at BabyLove to address these issues: First, Mama Cafe, free breastfeeding support on Tuesday mornings, has been around since day 1. Second, you can get one-on-one breastfeeding help in our office or in your home, with some insurances accepted, and more being added. It’s my way of not just talking the talk, but walking the walk.