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It’s World Doula Week! Ok, so maybe Ritchie Valens wasn't singing about Doulas, but now I am!

Doulas are a vital resource for families before, during, and after birth. When my own clients are working with Doulas, I know they will get the extra care and support they need as they navigate parenthood and breastfeeding. To celebrate World Doula Week I’ve invited Danielle and Megan, of Chesapeake Birth and Baby, to share about the work they do as postpartum doulas...
Much like the work Cynthia does, the doulas at Chesapeake Birth and Baby are there to help new families find their way. During those first weeks and months with a new baby, many parents feel unsure of their decisions- they’re acclimating to a new tiny human, new routines, unfamiliar equipment, and exhaustion- and facing so many outside opinions leaves these new families feeling confused. Our doulas are there to help parents navigate their way with their new baby to reach their goals for their family.

The doulas at Chesapeake Birth and Baby will help tend to the parents’ and baby’s physical and emotional needs, and offer researched-based support. We help the new family weed out all of the suggestions and judgments from the outside world, creating a space that feels right for them. There are ample opinions coming from almost everyone once a baby is born, but our doulas will help figure out what is best for the family, speaking to their values, wants, and needs.

The doulas are also there to help with light housework, so the piles of neglected dishes and laundry will get washed and put away. If nourishment looks more like a cold slice of turkey meat and some crackers between diaper changes than healthy balanced meals, we’re happy to prepare wholesome home-cooked meals. Because getting out of the house with an infant can seem like a monumental task, our doulas are available to run errands, or travel with the family to various appointments. We’ll even help pack the diaper bag so that nothing gets left behind!

Often when a family with more than one child hires a doula, it’s because they need to feel balance between the new baby and their first baby. Our doulas are just as comfortable with an infant as they are with an energetic four year old. Alternatively, we’re happy to tend to the baby’s needs so that the parents can spend special time with the older child(ren).

Essentially, whatever the needs of the new family are, we’re there to support. We know each family has different, ever evolving demands and desires, and so our doulas are trained to meet the individuals and help them work towards their goals. We’re there to help families thrive!

Here’s what a day with a doula may look like-
7:55am- Arrived early, let myself in the door, and said hello to the family upstairs
8:00am- Made breakfast for the children, and packed lunches for the day
8:25am- Helped the children get dressed for school
8:35am- Took the baby from the client, burped, changed, rocked her, and put her in her bed
9:15am- Collected the dirty laundry and threw it in the machine, unloaded and reloaded the dishwasher,
9:45am- Put tea pot on to boil, watered houseplants while it heated
9:55am- Brought client a nutritious snack and tea, and sat with the client to chat about how she’s feeling emotionally, and addressed her concerns about her postpartum life adjustment
10:45am- Switched laundry
10:50am- Meal planned for the week with the client
11:38am- Brought crying baby and a glass of water to the client
11:45am- Folded laundry and put away laundry
12:05pm- Burped, changed, and rocked the baby while the client took a shower
12:25pm- Went to grocery store to get items needed for the week’s meals
1:45pm- Returned to the house, put away the groceries
1:55pm- Brought the baby downstairs with me so that the client could nap
2:00pm- Played with older children while baby and client slept
2:25pm- Gave art supplies to older children to create with, began meal preparations for freezer meals and dinner,
3:40pm- Took crying baby to client for feeding
4:30pm- Cleaned up kitchen, put dinner in the oven
5:00pm- Said goodbye to client for the evening
Thank you, Danielle and Megan, for your continued support for my clients, and all the families you continue to support! 

Even if you didn't use a doula for your birth, Danielle and Megan are available to support you in this transition. Visit their website at https://www.chesapeakebirthandbaby.com/.
How did your doula help you navigate this new life we call Parenthood? 
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When the Indigo Girls sing, “It took a long time to, become the thing I am to you” clearly they aren’t talking about studying to become an IBCLC, but it certainly applies. As parents go through their own breastfeeding journeys some realize they want to help other people as well. They often start out in Peer-to-peer support, such a vital resource for new families, and soon begin to think about increasing their knowledge and expertise by becoming an IBCLC. Since I did not start out as an RN, nor in a peer support organization, I often have inquiries from people who are interested in chatting with me about the process. Just in the past few months, several women have contacted me to chat so I thought it was the perfect time to write about the process of becoming an IBCLC for someone who is not an RN.

​The IBCLC (International Board Certified Lactation Consultant) title is conferred by IBLCE (the International Board of Lactation Consultant Examiners).

There are three pathways to certification:

Pathway 1: Recognized health professionals and breastfeeding support counselors
Pathway 2: Accredited academic program
Pathway 3: Mentorship

There are many blogs out there describing the various pathways to certification and, as always, it’s important to become completely familiar with the information provided by IBLCE. I’m going to focus on Pathway 3: Mentorship, as that is the route I took to certification. When people reach out to me for information, it is not so much for the facts and details, but rather the experience, the personal take on the journey.

The three criteria IBLCE lists are Health Sciences Education, Lactation Specific Education, and Lactation Specific Clinical Experience. Since the IBCLC exam is the last step, I will add that as the fourth component.

Health Sciences Education - You will need to determine which courses you are missing based on your own college education. Eight of the courses must be for college credit; the other six may be continuing education.
  • ​​​Thankfully I only needed to take two of the college courses: Human Biology and Nutrition. You can take them at any accredited higher institution, including community college, a local university, or through an online course. I found it easiest to take courses online since I was still working full-time. If you are looking to save money, I do recommend looking into your local community college; they are often less expensive than other colleges and universities.
  • The continuing education courses may also be taken at a college or university, but you can usually find them online for a better rate. I took mine from Health e-LearningLactation Education Resources, and a local CPR course provider. I am not endorsing any particular organization; there are other sources out there as well.

*Tip* Start gathering your transcripts early to ensure you have proof of all courses to fulfill the education requirement.

Lactation Specific Education - All IBCLC candidates, regardless of which Pathway they choose, are required to take at least 90 hours in lactation and breastfeeding education. IBLCE does not recommend specific courses, nor do they approve them in any way. It is your responsibility to be sure the course you take meets the requirements as outlined in the IBLCE Detailed Content Outline.
  • There are many courses available to you, in-person, online, or as a hybrid. Since I was not coming from a healthcare background, I wanted to have some in-person learning. I chose to go through Breastfeeding Outlook, which provided a hybrid version of the course. I liked that I could go at my own pace for the online seminars and then have a chance to ask questions in person. I asked a lot of questions! This particular course was originally designed for RNs already in the field and there were times that was clear to me, as they spoke in “nurse” language, which is why I needed to ask more questions than anticipated. I believe they received that feedback from other students as well and I’ve heard the course has shifted and it is more accessible to non-RNs now.
  • Since then, I’ve heard great things about Lactation Education Resources and their online program.
  • You can find other LEAARC-approved courses at their website, Lactation Education Accreditation and Approval Review Committee. There is no requirement to take a LEAARC-approved course, but it may help you find available courses that you know cover the necessary topics.
Lactation Specific Clinical Experience - Here’s the big one, guys - 500 hours of directly supervised clinical practice. This is the step that is most difficult for those not already working in L&D or as a peer counselor. Where can I get my hours? How will I get them while working full time? Do I need to leave my job? Can I do them part-time? How can my family afford it?
  1. You can find your own mentor (and compensate that person(s) appropriately), or you can go through an organization that sets up mentorships for you, again for compensation. I bring up the compensation right away because many people go into this step thinking they can just find another IBCLC and work with them for free. Having a mentee takes extra time and commitment. If you find your own mentor, expect to create a contract, sign confidentiality agreements, and compensate that person.
  2. I signed up with Lactation Education Resources for their 500-hour Clinical Internship Program. They took me through the steps of having my Pathway 3 plan approved, set up my clinical sites, worked with me to ensure I was gaining experience in a variety of lactation scenarios, and provided additional learning modules. I paid the fee to them and they compensated my mentors as appropriate. They were able to place me in clinical sites I would not have otherwise had access to, which included hospital-based, group private practice, and solo private practice. I believe I received a more thorough clinical education than I would have found on my own.
  3. There are other companies that provide internship placements, so look for one in your area if that is the path you want to take.

​IBCLC Exam​
It’s finally time for that final step to which you’ve been working! The IBCLC exam tests your knowledge in the Clinical Competencies set forth in the Detailed Content Outline.
  • They used to offer the exam once a year, in July. They now offer it twice a year, in April and October. I took the exam in April, so I needed to have my clinical hours completed by mid-November, the deadline for applying for the April exam. All dates are available on the IBLCE site.
  • The next five months were spent studying studying studying. I reviewed my notes from my courses, read and studied Breastfeeding and Human Lactation and Core Curriculum for Lactation Consultant Practice. The books I used were the latest editions at the time I used them. Please use the most up-to-date textbooks when it’s your turn.
  • There are a variety of practice test books as well as online tests. I highly recommend taking practice tests from at least two different providers. Linda Smith’s review book, Comprehensive Lactation Consultant Exam Review is highly regarded. I also took practice exams through Lactation Education Resources, Breastfeeding Outlook, and the online portion of the Breastfeeding and Human Lactation textbook. They were all different and helped me see where I needed to study and which areas were my strongest.
  • One week before the exam I stopped studying. I had taken my courses, completed my hours, and spent many months studying. I knew I needed to give my brain a chance to rest before the big exam.
  • I was nervous the day of the exam, but I also knew I had worked hard to get there and done everything I could to succeed. I didn’t want to say it at the time for fear of jinxing myself, but when I left the test, I felt good. There was nothing on the test that completely threw me for a loop. Yes, there were questions for which I couldn’t decide between two answers, or I wasn’t sure exactly what they were trying to get to, but it was all within expectations. I knew I got questions wrong, but I also felt I did well enough to pass. And then the waiting game...the test is in April, but the results do not come out until mid- to late-June (October to December for the other test window).

Well we know I passed, or I wouldn’t be writing this and working as an IBCLC! Even with my relative confidence that I passed, the wait was not easy. When my results finally came in the mail on June 17, I fell to the ground and cried. I’m not kidding! I felt so much relief after all the work I did, the chances I took, and the financial struggle I created for my family. I was an International Board Certified Lactation Consultant!

I’ll save the steps of setting up a private practice for another post. That has its own pitfalls and triumphs!

Hopefully I’ve given you some insight into the process of becoming an IBCLC through Pathway 3. Get to know the Pathway 3 Plan Guide well. Know all your requirements for education, for clinicals, for having your plan approved (you have to submit it to IBLCE), and all your dates. Don’t forget to keep track of all your education along the way in case you are audited. None of the steps are hidden, but you are responsible for keeping on top of all dates and requirements.

If you are thinking about becoming an IBCLC, what is your biggest concern?
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We’ve all done it - we look to google for answers and information. The internet has provided us with the ability to access information more than any other generation. We have information and knowledge at our fingertips. But what if that information is incorrect? What if that information sends us down the wrong rabbit hole?

​Breastfeeding used to be a normal part of everyday life in a community; grandmothers, mothers, aunts, friends, all breasted around each other and learned from each other. We are physically more separated now, but the internet does provide a place we can ask questions and find answers. So where do we find accurate and helpful information?
I’ve gathered just a few of the websites where you can find helpful, trusted information about lactation and breastfeeding.

Kellymom.com - Kellymom is one of the top sites for evidence-based information. Kelly Bonyata, owner and creator of Kellymom, is an International Board Certified Lactation Consultant (IBCLC). Her articles help many families navigate issues and concerns and provide further references for follow through.

LactMed - Did you ever want to know how a certain medication might affect your milk supply or baby? From the National Library of Medicine at the National Institute of Health, you can search for both prescribed medications and over-the-counter products to determine whether or not they are safe to use while lactating.

CDC (Centers for Disease Control & Prevention) - While the CDC is not a support website, if you are looking for the latest official regulations and recommendations, it is worth visiting.

AskDrSears.com - Dr. Sears and his team are well respected pediatric practitioners. Visit his site for understanding normal infant behavior and common issues associated with breastfeeding and parenting.

La Leche League International - La Leche League has been providing peer-to-peer support for over 60 years. Along with their in-person meetings, they have forums and online groups for breastfeeding information and support.

Breastfeeding Medicine of Northeast Ohio - This organization provides in-person appointments and support, but they also have online information and resources from experienced IBCLCs. They are well-known and respected for their therapeutic breast massage and hand expression.

Information garnered online can be helpful in handling minor issues, or even reassuring yourself everything is going well. Online education is not a substitute for an in-person consultation with an International Board Certified Lactation Consultant (IBCLC). Please reach out to an IBCLC in your community for assessment, evaluation, and care.

What online resources do you find most helpful for lactation and breastfeeding?
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You’ve made it through the first few weeks of breastfeeding, gotten into a groove over the next few months, possibly went back to work and handling the hectic schedule, and then you see it looming ahead - 6 months! Starting solids (also called complementary foods) is an exciting time, but it’s also another learning curve, for both you and baby.

​This roller coaster is what parenting is all about - just when you think you’ve got it all figured out, something changes...
Just like with any parenting task, there is more than one right way to introduce solid food to your baby. We all know about the lines of cute little baby food jars in the grocery stores. Some people choose to make their own baby food, and others use what is called Baby Led Weaning. We’ll briefly discuss these options here, but you will definitely want to read more about whichever method fits your parenting style.

  • 6 months - Start solids at or after 6 months of age, with exclusive breastfeeding (or breast milk substitute) for the first six months. Both the American Academy of Pediatrics and the World Health Organization recommend starting solid foods at 6 months of age, or later.
  • Physical Readiness - Once your baby is 6 months old, s/he is ready to start complementary food when s/he is able to sit unassisted, hold his/her head up, and shows interest in your food.
  • Complementary Foods - Did you notice we’ve been saying complementary foods, along with solid foods? Solid foods in the first year of life are complementary to a baby’s main source of nutrition, which is breast milk (or breast milk substitute). That means breastfeeding, or breast milk by bottle, should come before foods during the meal. Babies are learning to eat solid foods, learning new tastes, and experiencing new textures of food. It is fun for them and an important developmental milestone, but it is not their main source of nutrition.
  • Baby Cereal - Baby cereal is not required! Most baby cereals are rice cereal and have very little nutritional value. You don’t have to feed your baby any cereal, but if you choose to, look for oatmeal or whole grains. Mix it with pumped breast milk for the best nutritional content.
  • Best First Foods - I know most of us think about starting with fruits and vegetables, but the nutrients a baby needs in the second half of his/her first year come from animal fats and proteins. Meats, avocado, and squash are good foods with which to start.
  • The Food - As previously mentioned, there is more than one way to feed your baby, and you don’t have to stick with just one way.
    • Pre-made baby food - Sold in grocery stores, they are easy to purchase and have ready when needed.
    • Homemade baby food - It’s easy to blend or mash up any food you want baby to have. You can make it in advance and freeze it in ice cube trays, or make it as you are making your own meal. You know exactly what your baby is eating, without extra preservatives added.
    • Baby Led Weaning - Let your children feed themselves! Baby led weaning allows your baby to learn how to handle different textures and sizes right from the start. This method has become very popular in recent years as families realize it is the normal way for humans to learn to eat, and control their own food intake. Be sure to read about it and watch videos so that you learn what babies can eat and how to do it.
  • Progression - From 6-12 months, your baby will begin eating more food, until they eventually eat three meals and a variety of snacks each day. When they are 12 months old, they will be eating everything the family does.

When your baby reaches 12 months or just beyond, they will probably be getting most of, or all, of their nutrients from their solid foods. You can continue breastfeeding and providing breast milk for as long as you both want. Breast milk continues to provide normal and optimal nutrition and immunities for your baby well beyond the first year of life.

But if you’re reading this post, you’re probably not at 12 months yet, so enjoy the next few months of your baby experiencing new foods - and making a mess!
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