IBCLC vs. CLC: an all-inclusive guide to choosing your lactation consultant

Becoming a new mother comes with a lot of other new experiences. Chief among them? Breastfeeding.

 

It’s a new skill for both moms and babies, so it makes sense that it requires a little training. With more than 4 million babies born in the United States each year, more than 70 percent of women choose to begin breastfeeding in the hospital but find they need help and support to keep at it. According to the Center for Breastfeeding, “Many women who choose to breastfeed are not achieving their own goals for duration and exclusivity.”

 

That’s why, even before you give birth, it can be a good idea to take a breastfeeding class if breastfeeding is important to you. Once you’ve had your babe, you can also look into drop-in clinics (babies welcome!) or other group classes.

 

And if one-on-one support sounds appealing, lactation consultants (LCs) are an incredible source of information. They can give insight into how to position the baby for feeding, how long to breastfeed, and how to communicate with your little one and pick up on signs they’re giving you. They have expert-level tips and tricks for breast tenderness or infections, milk production problems, and weaning.

 

Essentially, their role is to make you and your baby’s nursing experience as enjoyable and successful as possible. But choosing the right LC for you can often look like an alphabet soup of acronyms, because there are lots of different certifying bodies and training methods for lactation consultants.

 

Two of the most common acronyms are IBCLC vs. CLC—International Board Certified Lactation Consultant (IBCLC) and Certified Lactation Consultant (CLC).

 

What’s an IBCLC?

 

IBCLCs, or International Board Certified Lactation Consultants, are healthcare professionals whose expertise is in breastfeeding clinical management. IBCLCs are certified by the International Board of Lactation Consultant Examiners and provide support to breastfeeding mothers by offering leadership, advocacy, research, and professional development in several settings.

 

IBCLCs undergo 90 hours of approved breastfeeding education that covers human lactation and breastfeeding topics before testing their knowledge in a multiple- choice test that may last up to five hours. They participate in clinical practice in lactation to support, educate, and advocate for breastfeeding mothers before their exam to get firsthand experience with the education they’re consuming.

 

What’s a CLC?

 

Certified Lactation Consultants take a 45-hour course modeled after the WHO and UNICEF 40-hour breastfeeding counselor course. In it, students must demonstrate and adequately pass tasks in lactation care, like the ability to offer information and education to breastfeeding women, address physical and psychosocial aspects of the mother and baby, incorporate evidence-based approaches, and more. At the end of the course, they take written and multiple-choice exams, proctored by the Academy of Lactation Policy and Practice, a national nonprofit organization that provides the certification of lactation consultants to support breastfeeding families, that take upwards of two and a half hours.

 

The exam covers breastfeeding education and competency, and students also need to demonstrate lactation support skills that “are governed by the scope of practice and the code of ethics while working with patients and clients,” according to the Center for Breastfeeding. This educational and training foundation allows CLCs to practice tried-and-true, education-based guidance and skills, guided by WHO and UNICEF standards.

 

IBCLC vs. CLC: Why the distinction?

 

Lactation consulting is a largely unregulated industry, and most states don’t actually require a license for someone to practice professional lactation consulting. Just four states do: Rhode Island, Oregon, Georgia, and New Mexico. And in Georgia, only one certification is approved: the IBCLC.

 

Among the lactation consultant community, there’s some back and forth about the equity of IBCLCs vs. CLCs. CLCs purport that their training qualifies them just as much as IBCLCs to help breastfeeding women. This blog post from a doula with both CLC and IBCLC designations, says they’re really not the same.

 

For one, IBCLC requires thousands of hands-on clinical hours working with breastfeeding moms under mentors. One commenter on the post writes: “I went through the CLC course as a [segue] to IBCLC. … I often compare it to the nurse’s aides vs registered nurses. Both can do bedside care but who would you want to administer your IVs or blood [work]?”

 

However, the CLC course has value, too, because it ultimately improves access to the certification process. Its requirements are more digestible, affordable, fast, and readily available for those wanting to become LCs. This article describes a CLC like this: “The individual has taken a course—usually about a week long—and given a certificate. No prerequisites or prior learning required. Great for teaching classes, and for helping with the normal course of breastfeeding, but not for consulting with moms/babies with challenges that don’t resolve quickly. CLC is not the same as IBCLC.”

 

In contrast, to become an IBCLC, you need to either already be in the medical, nursing, or clinical field with a degree to support your role, or you need to have taken and passed the following prerequisite courses: biology, human anatomy, human physiology, infant and child growth and development, nutrition, psychology (or counseling or communication skills), introduction to research, and sociology (or cultural sensitivity or cultural anthropology).

 

In other words, you need to have some extensive education to even be eligible to begin coursework and clinical hours for the IBCLC qualification. On top of that, IBCLC training isn’t available in all states yet. No wonder CLC certifications have “taken off,” as one commenter put it.

 

Overall, both CLCs and IBCLCs do provide competent expertise and knowledge to new moms, although they’re trained in vastly different ways and have completely different levels of experience.

 

IBCLC vs. CLC: How do you decide whom to work with?

 

Many doulas, nurses, childbirth educators, nutritionists, doctors, counselors, and mothers who want to help other mothers have lactation certifications to support women and babies with breastfeeding. Often, too, hospitals have lactation consultants and counselors on staff to guide new moms through the process of learning to breastfeed successfully. However, as with so much in the mom world (!), public and professional opinions about IBCLCs vs. CLCs vary widely and are quite polarizing.

 

You might hear, for example, that CLC is the entry-level certification, while IBCLC is advanced. It’s important to note that both types of lactation consultants undergo significant training and education. Both practitioners are generally expected to perform the same tasks: assessment, education, advocacy, and counseling.

 

Both CLCs and IBCLCs aid women in achieving their breastfeeding goals. The presence of each in the healthcare field is crucial, especially as many women face difficulties with their breastfeeding desires. The CLC certification is far less cumbersome, more widely available, and more affordable, and they certainly have their strengths in the breastfeeding education world. However, IBCLC participants go through a far lengthier education, clinical training, and certification process that position them as experts in especially challenging or unique situations.

 

Because they both have their strengths, the most important thing to consider when choosing your lactation consultant is the validation of their credentials, their experience, and personal fit.  Just like choosing any medical care provider, you want to do your research and check out how long they’ve been practicing and whether they have specific experience with something that might be troubling you. And, since breastfeeding is an intimate and important endeavor, you want to connect with them and trust them. Just like many things with motherhood, to a certain extent, you’ve got to trust your gut.

 

 

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What to expect when you’re no longer expecting

I have been pregnant three times. I have given birth once. But my two miscarriages, which occurred within a year of each other and 18 months after the birth of my daughter, were very different from each other. Both times, however, I found that I was ill informed and unprepared for how to deal with the experience.

 

 

My first miscarriage came early: I had about a week of knowing I was pregnant before I was texting my aunt, a labor and delivery nurse, about my symptoms, asking her to confirm what I expected was happening to my body. It happened around four weeks and was relatively anticlimactic: I cramped, I bled, I grabbed a pad from my desk and went to the bathroom to take care of the bleeding. Afterwards, I turned to Dr. Google to slake my curiosity: How long does a miscarriage last? Do I need to see a doctor? Can I take a bath?

 

When I typed in “miscarriage,” however, most of the results were emotional pieces, personal essays, and anecdotes about losing a baby. Although I was disappointed, I wasn’t really interested in the emotional ramifications of miscarrying. What I wanted to know was more procedural. I wanted to know what to expect from my body; I wanted to know what was normal and if I needed to keep an eye out for any signs of complications. This is that piece, because I’ve now realized that normal can bring different meanings.

 

A few months later, I was pregnant again. This time I made it to my eight-week appointment before finding out the baby didn’t have a heartbeat. Miscarrying was different this time around. My doctor told me I was no longer pregnant, but my body hadn’t caught up yet. I had two options: wait to miscarry on my own or schedule a dilation and curettage (D&C). I did not like the thought of having someone scrape the inside of my uterus, so I left the hospital hoping my body would catch up to my grief.

 

It took about a week. I assumed that, physically, this miscarriage would be like the last one—basically a period with more emotional baggage. It was not. This miscarriage physically rocked my body. It started with a pop in my uterus and a gush of liquid that filled my sweatpants. Then, the pain set in.

 

Pale and sweating, I waddled down the hallway, pain shooting deep throughout my abdomen. My vision blurred and my body trembled as if I was going to throw up at any moment. Fluid I assumed had something to do with my amniotic sac, blood, and a large collection of tissue exited my body over the course of the next hour. Eventually, exhausted, nauseous, and shaky, I understood that it was over.

 

The next day, I turned to Google again. My doctor hadn’t explained to me what I should expect, what level of pain I might feel, or what fluid consistency was normal. After the birth of my daughter, I got 24 hours of poking, prodding, and middle-of-the-night check-ins. I was hooked up to machines and had to be discharged. I knew miscarrying at eight weeks wasn’t the same as pushing a seven-pound baby out of my body, but I also had no reference for normal. There is no What to Expect miscarriage edition. I was astonished to see how few resources existed.

 

I spoke with my aunt again, who reiterated what I was able to find: rest, manage, and grieve. I found there is not much concern around a miscarriage. I needed to monitor for a fever or infection, but ultimately my body would know what to do. There was irony in that realization—that the body I trusted to keep my baby alive was now being trusted to expel the remains appropriately. The timeline for recovery after giving birth is averaged at about six weeks, but I couldn’t find a timeline for miscarriage recovery. At six weeks postpartum, I had a brief check-in with my doctor. Weeks after my miscarriage, no medical professional checked in.  

 

Since then, and based on what information is out there and what I was able to learn, I created my own guidelines:

 

  • Physical pain management—ice packs, heating pads, and pain relievers. With both miscarriages, I experienced some level of discomfort and pain, the second one being more intense.
  • Rest—sleep, binge Netflix, call in sick, sit on the couch for hours, don’t shower if you don’t feel like it. Slow down and let your body heal.
  • Be informed—talk with your doctor or the nurses. If you have questions, ask. I pay an obscene amount each month for an alarmingly high deductible and calling a doctor is free. Google  your specific questions. Although I didn’t find much overall, I was able to find some information about what I needed to look out for. When I searched specifics, I was able to find out that I did want to monitor for a fever and infection.  Search mom boards and ask your questions there. I found reassurance in those boards knowing that women were experiencing the same effects as I was. The boards weren’t just about how we were feeling, but what we were experiencing physically as well.
  • Ask for help—Start a meal train or have a friend start one. Hire a housecleaner for the week so you have one less thing to worry about. One thing I hadn’t considered was hiring a postpartum doula. I didn’t realize these existed when I was pregnant with my daughter but found out about a year after she was born. A postpartum doula comes after you’ve given birth and helps you in the “fourth trimester.” Many will cook and clean, snuggle baby while you shower, and listen to how you are doing. I don’t know that it’s conventional to hire one when you have a miscarriage, but why not?
  • Find time to grieve—I avoided this step the most. Seeking knowledge and focusing on the process helped me grieve, but I found I also needed to grieve in other ways. Journaling, talking with friends, and expressing my disappointment with my husband all helped me get myself out of bed. My husband wrote a letter to our unborn baby; my friend named and buried hers.

 

Miscarrying was scary, and so was finding such little information about what was normal. There wasn’t really anything I could do about what was happening to my body, but I was able to control how I took care of myself, physically and emotionally, after my miscarriage.  

 

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Insider tips for choosing the best birth team

As a new mom-to-be, it can be overwhelming to dive into the world of obstetrics and wrap your head around some of the simpler things, let alone choose the right provider.  But this is actually one of the most important decisions you make to ensure a good birth experience, and taking action before your first visit can help you find the perfect birth team for you. I worked as an administrator in women’s healthcare for over a decade, and there are some key things to keep in mind when choosing your doctor, midwife, doula, and birth class.

 

Get to know your birth team

 

Finding a physician or midwife who will be a good fit for you and your needs is an imperative first step for having  a positive experience from prenatal care all the way through postpartum support.

 

Schedule a consultation visit or attend a “meet the provider” group event. This is the best way to “shop around” for a provider and learn about what you can expect from the experience. It also gives you a chance to get to know the staff at the office; they are just as integral a part of the birth team.

 

Ask tough questions of your birth team 

When you meet with doctors or midwives, bring a list of questions with you and don’t be afraid to ask about whatever is important to you. This is your birth; it’s a private, personal experience and you want to make sure your provider understands exactly what you are looking for.  

 

Things that are important to know would be:

 

  • What is their primary cesarean rate? The overall will include VBAC deliveries or repeat C-sections, so it’s good to know the stats for what applies to you.
  • What is their episiotomy rate, and do they perform them regularly or only if medically necessary?
  • What is their call schedule like at the practice? Do they rotate call, and does that mean someone who you haven’t met could be at your birth?
  • Insurance! Is the provider in or out of network, and will you owe any copayments or coinsurances? In the years that I worked in medical billing, I was shocked by how many people didn’t have any idea about their maternity coverage within their health plan. Pregnancy can be an expensive insurance claim, so learn about your coverage so you’re prepared.
  • If the birthing facility is a hospital, are they mother and baby friendly? Do they have any policies about induction, cesarean, or early discharge restrictions you should know about?
  • If your facility is a birthing center, what is their transfer rate, and what would a transfer look like?

 

See how far you are from the back up hospital in case of emergency and see if the facility is state licensed and accredited. Take a tour of the facility where you’ll be delivering. Do they have a NICU and what level of care do they provide? What type of postpartum support is offered? How the facility looks is nice, but it is the skilled, safe hands of the provider and staff that are most important. You’ll remember the nice nurse who held your hand more than the thread count of the sheets.

 

Be honest about what you need in a birth team 

 

Consider what you want from your labor and delivery experience, and create a birth plan that suits your needs. A hospital or birth center can help you create one, but remember that with the unpredictability of childbirth, flexibility is key.

 

Decide if you want a medicated or unmedicated delivery, and who will be in the room with you. Being honest with yourself about your personality and your needs is a great step to choosing a doula, birth class, doctor, or midwife.  

 

Are you a procrastinator? Maybe a class like hypnobirthing wouldn’t be a good fit in this case. Are you an information junkie? A class like the Bradley Method that gives you an overabundance of clinical knowledge might be a good fit.

 

Do you require tough love or a nurturing presence? This helps you pick providers and find a doula with a more motherly bedside manner, or with a no-nonsense attitude that is going to be stern but caring during your labor. My boss at the clinic used to say that people give birth the way they live their lives, so it is a good time to have a little self-reflection.

 

Do your homework on your birth plan and birth team 

 

One of the best ways to have a positive pregnancy and delivery experience is to be an active participant in your healthcare. Giving informed consent to procedures and making informed choices can make a world of difference and help you feel like you’re part of the decision-making process. Friends and family often have the best suggestions, so first ask people you know and trust (tread lightly with online reviews, which may not be as reliable). Check organizations like the American College for Nurse Midwives (ACNM), the American College of Obstetrics & Gynecology (ACOG), the American Association of Birth Centers (AABC), and Commission for the Accreditation of Birth Centers (CABC). These will give you names of practices and providers who are licensed and are part of organizations that put safety and quality first.

 

Go with your gut about your birth team 

 

So often, patients joined our practice after having a previous birth with a different provider they weren’t satisfied with. The biggest complaints were that their previous providers didn’t spend enough time with them, they weren’t informed about their care, or they didn’t feel heard. The best secret I can share with you is to start going to your doctor or midwife before you’re pregnant. These providers will see you for routine gynecological services, and this is the best way to learn if they are someone you can trust for your pregnancy or any other complicated reproductive issues.

 

If you don’t feel comfortable or see red flags, make a change. But be aware that practices, particularly solo practitioners, have a cut-off of a certain week’s gestation, after which they won’t accept transfers.

 

The sooner you choose a provider and find a doula, the better. You’ll have more appointments with the same practice, you can get to know each other, and you’ll feel confident that they’ll take your needs into consideration during labor.  

 

 

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When did formula become evil?

“I just want to tell you that if you keep supplementing so much with formula,” my postpartum doula warned, with more than a trace of judgement in her voice, “you’re going to wind up with a completely formula-fed baby.”

 

 

I nodded weakly and wondered to myself, Would that be such a bad thing? Yes, breastfeeding had been my goal, but I was starting to doubt that my Herculean efforts were worth it.  

 

“Breast is best” had been drilled into my brain for my entire pregnancy, and when my boobs didn’t produce the abundance of milk I’d been assured they would, I felt like a failure. My milk didn’t come in until eight days after my daughter was born, despite my pumping around the clock. My newborn baby’s favorite thing to do with my boobs was fall asleep on them. I was struggling with an every-three-hours cycle of attempting to breastfeed, supplementing with formula, then pumping, and I was barely getting through each day. Postpartum depression was closing in on me. This was not remotely how I’d envisioned the first few weeks of motherhood.

 

I couldn’t understand why I couldn’t do for my baby what every mother around me seemed to be doing: giving her the gift of breastmilk, the “liquid gold” that everyone had told me was the far superior way to feed your newborn. However, as devastated as I was not to be breastfeeding exclusively as planned, I was able to recognize that formula was truly a lifesaver for my daughter. In fact, formula has been a literal lifesaver for countless babies since its invention in the late 19th century. Before formula, women who couldn’t breastfeed relied on wet nurses, animal’s milk, or things like bread soaked in water to feed their infants.

 

By the 1950s, formula was widely accepted as a healthy and safe alternative to breastmilk, so much so that breastfeeding fell out of fashion for a couple of decades, especially as more and more women joined the workforce. But in the ’90s, breastfeeding saw a resurgence in popularity, and with the World Health Organization and UNICEF’s Baby Friendly Hospital Initiative encouraging exclusive breastfeeding, “breast is best” became the rallying cry for new mothers everywhere.

 

Is breast really best? It depends on so many factors. On the one hand, it’s completely natural, a great way to bond with your baby, and comes to you free of charge. But what if you’re a mom who’s unable to breastfeed for any number of reasons? Should you turn down formula just so you can say your newborn is exclusively breastfed? Not unless you want to risk serious health challenges for your baby. So why the shame surrounding formula feeding?

 

Jody Segrave-Daly, a NICU and newborn nurse, board-certified lactation consultant, and cofounder of the nonprofit organization Fed Is Best Foundation, says, “There is a massive misunderstanding of what formula milk really is. There is nothing sinister lurking in formula milk.” She firmly believes that “fed is best,” noting, “The breastfeeding information that is shared is often not accurate and sometimes downright dangerous. There are indeed benefits of breast milk for the babies who can thrive on it, but unfortunately, the benefits have been grossly exaggerated.”

 

Science backs up what Segrave-Daly is saying. Research in the past few years indicates that “the benefits of breastfeeding children are exaggerated and the emphasis on breastfeeding might be leading to feelings of inadequacy, guilt, and anxiety among mothers.”There is no need for women like me to stress out about not being able to breastfeed, but we do it anyway—many of us as a result of the oversimplified “breast is best” mantra. And it’s worth noting that some of the research about the benefits of breastfeeding is funded by companies such as Medela, which makes breast pumps.  And then there’s the enormous market for breastfeeding accessories: nursing pillows and clothing, pumps and pump parts, lactation teas and supplements, special nursing chairs. Yes, the formula industry is massive too, but the companies that sell these breastfeeding products greatly benefit from the “best is breast” movement—and push it pretty hard.

 

There is also a misconception that a baby who is given supplemental formula in the first few days of life will “choose” formula over the breast and not be able to breastfeed, which is simply not true. And for many women, supplementing with formula in the early days is essential if they’re not producing enough colostrum or if their milk hasn’t fully come in yet. According to Fed Is Best, 23 percent of first-born newborns who exclusively breastfeed wind up with low blood sugar levels, which, if not addressed, can affect cognitive development. Excessive jaundice can also result from insufficient feeding in a baby’s first few days.

 

Segrave-Daly says, “There continue to be many unintended consequences of promoting exclusive breastfeeding at all costs. These consequences are completely avoidable, and as health care professionals, we need to find a balance again of how we promote breastfeeding while supporting those who can’t or choose not to.”

 

For many moms, using formula isn’t a choice, it’s a necessity. Whether they’re adoptive or foster moms, moms who have a delayed or low supply (an estimated 15 percent of women), or moms who simply don’t want to breastfeed, they should be able to use formula without feeling shamed or judged.

 

“The shaming has caused needless suffering for nearly every mother I work with,” Segrave-Daly observes. “Social media platforms have provided a voice to shame others. I have noticed anti-feminism, mean-girl attitudes, and religious beliefs all factor into this beast. It really mystifies me personally why this is happening, as no matter how we feed our babies, we face shame. We should be advocating together to end all infant feeding shaming.”

 

I was lucky not to experience excessive formula-shaming when my daughter was a baby, though I still remember a mom I barely knew at a playgroup asking me, as I mixed my daughter’s bottle, “Why aren’t you breastfeeding?” She didn’t know me, she didn’t know my circumstances, and frankly, it was none of her business. I told her I was unable to breastfeed and left it at that, but believe me, in my head I had more than a few choice words for her.

 

Bottom line: I had truly hoped to breastfeed my daughter, and when it didn’t work out, I suffered. I got over it eventually, but it wrecked me for a long time, largely because of the attitudes surrounding “breast is best.” I feel so fortunate that when my son was born in 2017, there was a lactation consultant in the hospital who recognized on day two of his life that he was hungry and needed supplementation since I wasn’t producing enough colostrum. I so appreciated that she, a woman whose job was to encourage breastfeeding, told me about the importance of using formula in my circumstance.

 

If you can breastfeed, and it’s enjoyable for you and your baby, by all means, do it. But not all moms can, and sending the message that breastfeeding is the be-all and end-all can be toxic. Because of formula, I was able to restore my postpartum sanity. Because of formula, I have two healthy, robust, thriving kids. I chose to feed my babies formula because it was the way that worked best for all of us—and there is no shame in that.

 

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Navigating healthcare like a pro

Many women turn to Dr. Google the moment they become pregnant. After all, most physicians won’t see an expecting patient until after the eight-week mark. With appointments getting shorter and shorter, it’s no wonder that many patients leave the doctor’s office eager to claim agency and make confident choices—and find that on the internet. Unfortunately, though, not all info is created equal, or credible.

 

As a healthcare consultant, I use a lot of public and proprietary databases of information to build on my understanding of patient populations and communities at large. There’s plenty of reliable info out there, but it takes some digging to find.

 

Below, I wanted to share a list of some of my favorite data sources—an insider’s scoop—to help women feel confident in their decisions.

   

Choosing a healthcare provider 

 

Say you haven’t found the best pediatrician or obstetrician, or you’ve changed insurance and must part ways with your old provider. While word of mouth is obviously a strong motivator, it’s not always possible. And there are many data sources that allow women to be extremely informed about the providers they see.

 

  • Every state has a licensing board. You can check on disciplinary actions by individual or provider type. Here is an example website for Illinois. You may be able to search for nurse practitioners and certified nurse midwives as well.
  • The Centers for Medicare and Medicaid Services (CMS) runs Physician Compare, which allows you to view a profile for a CMS-certified provider and check on their general information and whether they participate in CMS-quality initiatives. You may also be able to see data on their performance.

 

Choosing a hospital

 

It is becoming a well-known fact that the site of birth has a major impact on labor outcomes. Choosing a site of care for this milestone is so personal. There are several resources to keep in mind to make an evidence-based decision if you are lucky enough to have multiple options nearby.

 

  •  First, every hospital maintains data on hospital and emergency room stays that it must report to the state government. As a result, every state has information on hospital stays and most do have some sort of patient- or consumer-facing interface where patients can review safety and quality metrics. Here are two examples, from Illinois and Arizona.
  • CMS Hospital Compare functions similarly to the CMS Physician Compare site, providing general information on the quality of care at over 4,000 CMS-certified hospitals.
  • Leapfrog also maintains a Hospital Compare site allowing patients to compare multiple hospitals on a variety of metrics including pediatric and maternity care, infection rates, and so forth. Leapfrog also shares data on early elective deliveries, C-sections, episiotomies, and high-risk deliveries by hospital. These are important stats to bear in mind, because they can be an indicator of how hospitals tend to handle a situation. Here is an example of the information Hospital Compare provides. It also offers Hospital Safety Grades.
  • Most hospitals, especially children’s hospitals, provide outcome and safety data on their sites. Examples of key metrics to review are serious safety events and cardiac surgery outcomes.
  • Some specialty and professional organizations also have data repositories that help you make better decisions about surgical or procedural outcomes. This is especially true for cardiac and congenital heart surgical outcomes and fertility clinics. The Society for Thoracic Surgeons allows patients to view surgical outcomes by hospital. The CDC also allows you to compare fertility clinics and understand the outcomes of their cycles by year. Researching fertility clinics that have the greatest average chances of success may be worth it since it is such an expensive and time-consuming commitment.
  • Most birth centers that are accredited are listed and licensed birthing facilities can be found on state health facility registries.
  • For many years, patient billing data has been used by the healthcare industry to make informed decisions about how patients access and use healthcare services. But it hasn’t been accessible to consumers. Recently, USA Today set out to collect some of this information to help its readership understand obstetrics outcomes and severe maternal morbidity rates by hospital. This can help patients understand how often women giving birth experience severe complications at a specific hospital. Of all the states surveyed, only 13 provided data on a cohort of 951 hospitals. USA Today created the Childbirth Complications Rates at Maternity Hospitals Database to provide that data along with C-section rates when possible.

 

After birth and beyond

 

 

Making informed, confident healthcare decisions can be stressful and overwhelming. But if the way you seek to overcome those feelings is by doing research, know that you’ve got resources to help you make the right choice.

 

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What is a doula? And how to decide if you should use one

For centuries, women have helped each other through the childbearing process by providing one another physical and emotional support. Doulas offer this same sort of support through education, encouragement, pain-relief techniques (like massage and breathing tips), and uplifting coaching throughout the birth of a baby. Even Meghan Markle is said to have consulted a doula for the recent birth of her baby boy, and Amy Schumer sang the praises of her doula after her son’s birth (though she found herself asking, “What is a doula?” too).

 

You may be wondering if working with a doula is for you. But what is a doula, exactly, and what does she do? We’re here to provide everything you need to know about what is a doula, the benefits of having a doula, a doula’s role is, and how a doula can impact your delivery.

 

What is a doula?

 

The word doula comes from the Greek, meaning “women’s servant,” and a doula is a professionally trained childbirth expert who offers physical, emotional, and educational guidance to expecting moms. Doulas strive to help pregnant women experience the most positive, safe, and empowering pregnancy and childbirth process possible. They can help women develop their birth plans so they know what sort of experience they want, where they’d prefer not to compromise, and how to feel empowered over a process that can’t really be controlled.

 

You can think of a doula as someone like a birth coach who acts as an encouraging assistant throughout pregnancy and delivery. While lots of attention is rightly paid to caring for the baby, the doula represents the mother.

 

The most commonly thought of doulas are birth doulas, who support labor as a mother’s companion.

 

They do not take the place of the mother’s husband or partner during delivery. In fact, doulas often encourage and help the partner to use comforting techniques and emotionally support him or her during the birth process, as well.

 

What is a doula going to do?

 

Usually, doulas begin working with expecting mothers a few months before the delivery date. They build a relationship with each other and work together to create a birth plan that fits the mother’s expectations and hopes. Doulas are not medical care providers, but they are well-versed in most medical components of labor and delivery.

 

This knowledge and understanding of pregnancy and birth allows doulas to walk mothers through the procedures and potential risks throughout childbirth. Doulas can be helpful for any type of birth, medicated or unmedicated, but many women have reported needing fewer interventions (such as medication or cesarean sections) with a doula.

 

One study shows that women who have doulas are reported to be 39 percent less likely to have a cesarean birth, 35 percent less likely to have a negative birth experience, and 15 percent more likely to have a spontaneous vaginal birth.

 

A doula is there to be an advocate for a pregnant woman. They uplift and support mothers in undergoing their desired plan for birth. The entire goal of having a doula is to help moms go through positive and safe births, not to give unsolicited medical advice. After delivery, doulas help mothers and other family members bond with the baby. They also help start the breastfeeding process.

 

There are also antepartum doulas, who give support to women who are on bed rest or have high-risk pregnancies, and postpartum doulas, who provide support during the weeks following birth. These doulas provide practical support and encouragement during often overwhelming and stressful times.

 

What is a doula’s benefit?

 

Childbirth can be a scary and overwhelming time, especially if things don’t go according to plan. But now that you know what is a doula’s role and what is a doula’s tasks during labor, here are the ways that having a doula can help during pregnancy, delivery, and the postpartum period.

 

What is a doula going to help you with? Having a doula can:

  •      Reduce stress and anxiety during labor with the power of touch, pressure points, and massage
  •      Help mothers understand the medical processes and possible risks in late pregnancy and labor
  •      Provide active support, guidance, comfort, and answers to questions in the months leading up to delivery
  •      Decrease the odds of needing a C-section, length of delivery, use of oxytocin, and desire for epidural, according to some studies
  •      Help mothers breastfeed and the family connect with the new baby
  •      Create a more positive and empowering environment during childbirth
  •      Encourage husbands or partners to participate or offer reassurance

 

What is a doula’s role during delivery?

 

Simply put, doulas provide expecting mothers:

  •      Physical support, like position suggestions to help with labor discomfort, breathing techniques, and a comforting touch.
  •      Emotional support by being a tender,  and nurturing, andyet reassuring, presence to all family members leading up to and during birth.
  •      Partner support by educating and encouraging any level of participation the mother’s partner or family members are comfortable with performing.
  •      Evidence-based information and advocacy, as doulas “serve as a bridge of communication between women and their providers, lifting them up to help them find their voices and advocate for the very best care,” according to DONA International, an esteemed doula certification organization.

 

Doulas are not medical doctors, but they have a vast knowledge of medical practices so they can as to act as an intermediary between a pregnant woman and her doctor or midwife. They’re also different from midwives, who are healthcare providers who offer prenatal care and deliver babies in hospitals, birth centers, and homes.  

 

Not everyone needs or wants a doula for their labor, but there are certainly some powerful perks to using one. If you’re thinking about finding a doula, it’s important to seek one out that you feel comfortable with and connect with easily. You want to be able to ask them any questions you might have, so do some research and set up a few consults to see who you click with best.

 

 

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Baby season

Birds, bare legs, and bicycles. After months of gray, spring has finally begun to show its sunny face in Michigan. Suddenly, moods—like the days—are brighter for longer. I’m wiping the built-up dust off of last summer’s memories, brushing away the stray dried leaves. I won’t mind tending to the flowers in our yard because it’ll also mean we’re out of the weeds.

 

snow-covered tree lot during daytime

 

Michigan winters are brutal, long, and cruel, yet as I prepared to become a mom six years ago, the idea of indulging in the cozy aspects of winter leading up to my early March due date was a welcome one. So was the thought of holing up with my husband and newborn daughter, leaning in to every reasonable excuse to sit and veg until spring came around. And we did just that, occasionally escaping the house on a rare 50-degree day for a walk around the block. We welcomed visitors with their casseroles; they eagerly held our new little girl and posed for photos while we did our best to make conversation on such little sleep.

 

Such. Little. Sleep. The time I spent preparing my mind and body for what would happen in the hospital delivery room ought to have been spent waking up every two hours to understand life with a newborn. It might have been less of a shock that way. But beyond the physical exhaustion, there were also brand-new emotions.

 

Suddenly, I felt more alone than ever before—despite having a supportive husband and family, let alone another tiny human being in my arms or at my side at all times. “You, me, and the baby makes three,” right? Yet in the blur of both of my girls’ first years on this earth, what I remember are the times of complete elation and isolation.

 

All it takes is a moment to bring my mind back to those hours in the middle of the night that I spent nursing and rocking and swaying my daughters, feeling like that would be my reality forever. Or the time I stood in a bathroom stall during a family party, nursing my firstborn, still years and a second baby away from feeling comfortable enough to breastfeed in public.

 

When I decided to switch to part-time employment and primarily work from home after having my first daughter, the isolation became overwhelming. The wellspring of visitors had long since dried up, and the majority of my adult interactions were now over work email. I became adept at typing on my laptop over the Boppy pillow, but trying to return to my pre-baby work self was harder than I expected. I attempted to fit my full-time tasks into my new, part-time schedule, wanting to show I could still balance it all. When I let my daughter cry in her crib an extra few minutes so that I could wrap up a conference call, I felt like a bad mom. When I took breaks from editing news articles to snuggle with her, I felt like a bad employee. Staying home alleviated the worries of pumping milk and separation anxiety, but it also kept me in a limbo state.

 

I longed for the early newborn days when my only job had been to keep my baby alive. Showering could be optional. Emails weren’t piling up in my inbox. How strange that at my peak of accountability, I was looking to opt out of any extraneous responsibilities. But as our daughter grew older, I found it easier to make my way back into the pace and social atmosphere of the workplace.

 

Despite my fears of the isolation I’d experienced the first time around, having our second baby in yet another Michigan winter only enhanced my desire to dive deeply into hibernation. Perhaps it was because I knew she was going to be my last baby, or because I was overwhelmed by the prospect of balancing everything as many of my peers do, so gracefully, each and every day.

 

In addition, we experienced challenges with our second daughter that we never faced with our first. While nursing went fine, she never took a bottle, even after a tongue and lip-tie correction and weeks of craniosacral therapy. We visited the pediatrician and a dermatologist on several occasions for her sensitive skin. I remember wondering how I would be able to leave my sweet second-born, who seemed to need more of me than our first, to return to work.

 

It only took a week back from maternity leave—with a perpetual lump in my throat and a baby who refused to eat for our babysitter—for me to make the decision clear in my mind. With support from my husband, family, and friends, I left my job for full-time motherhood, which I felt drawn to even more than to the work I loved.

 

Now, there are days my husband will come home from work and I’ll realize I haven’t spoken to anyone over the age of six all day. Sometimes I catch myself giving him an extended verbal download of the day just to reach my daily word count; it’s as if the words build up inside of me, my mom mode like a kink in the hose for all of the things I wish I could say.

 

The decision to quit my job was not easy, nor have the two years since been. But once I decided to do it, it was like shrugging off the weight of a woolen winter coat. It was one less thing on my plate. I could focus all of my energy on my family instead of letting deadlines and meetings crowd my mind, which was already swirling with doctors’ appointments, grocery lists, and craft project ideas. While I gave up workplace interactions, my network of mom friends grew. Instead of complaining about a coworker, we complain about potty training. Even when we feel like we’re alone, we’re in the trenches together.

 

The promise of spring also keeps me moving forward. Now as a mom with a toddler, grade schooler, and a growing pile of infant toys ready to be donated, I see those early baby years as their own winter of sorts, too. I’ve made it through that season of my life as a mom, with its endlessly long days punctuated by joy-filled moments. I am finding time to be something other than mama, whether it’s writing or taking barre classes. New challenges are certain to bloom, but I know it’s okay to stop, take a breath, and focus on the flowers.

 

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The top 13 questions to ask a doula

Doulas can be a tremendous asset and comfort for women in labor. They act as encouragers, coaches, and even masseuses to support women through the entire birthing process. A doula’s primary goal is to help women go through the birth experience they desire. They are professionally trained in a way to provide pregnant women physical, emotional, and educational support in the days leading up to the due date, as well as throughout labor.

 

Hiring a doula can actually improve your odds of having a spontaneous vaginal birth and lower the chances of cesarean birth. Many women have reported needing less pain medication when they bring a doula into the mix, and doulas help reduce stress, explain medical processes, provide guidance and assurance, and create a more positive birth experience overall.

 

It makes sense to do your homework when selecting a doula for the birth of your child. She will be an extension of your birth team, so it’s important that you click with her, trust her, and enjoy her presence. Finding the right doula for you is all about asking key questions and selecting someone who understands your preferences.

 

At Motherfigure, we recommend interviewing at least two candidates so you have more than one option to choose from. For a few ideas on where to start with interview questions to ask a doula, check out our list of the most important ones that will allow you to get to know her and see if she’s the right fit.

 

The best questions to ask a doula in interviews

 

Start scheduling interviews after you’ve pulled together a list of candidates. You may want to determine your budget and the characteristics you’d like to find in a doula before meeting with your potential picks. Just like job interviews, it’s important to take notes and ask honest questions about their support style, experience, and approach. Listen intently and openly to their answers before making any decisions. And above all else, choose the doula who you click with and trust to be an advocate throughout this process.

 

  1. Are you available on my due date?

 

Of course, this one is major. Many doulas only take on one or two clients per month in order to ensure that they’re there to support them whenever they give birth, but sometimes babies have different plans! If a doula is already booked on your date or even relatively close to your date, she’ll probably let you know before you even get to the interview stage.

 

  1. What is your training and background?

 

While the doula practice is professionalizing, it’s not regulated, and trainings and certifications are fragmented. There are several doula trainings available, so do a little research and digging into your candidates’ training and certificates. DONA and CAPPA are two widely recognized trainings, but some doulas prefer to not be trained or certified, or are “self-trained.” Because this is a profession that deals with serious education and helps bring life into the world, it’s really important to work with a doula who is legitimately trained and who follows a code of ethics.

 

  1. Do you have a specific philosophy about birth?

 

There’s no real right answer for this, just as there’s no right answer for your own philosophy (though, here at Motherfigure, we advocate for being as adaptable and open as possible—much as we might try, we can’t totally plan a birth). Look for cues that your doula’s philosophy matches up somewhat or completely with yours. A doula’s role is not to convince you to proceed with your birth in any certain manner, but to support you through the birth process you choose. And, ideally, they should be nonjudgmental–both about your philosophy and about changes that might happen in the moment. This question will ideally allow you to get to know the doula better and what she values in this work.

 

  1. What inspired you to become a doula?

 

This is another fantastic get-to-know-you question that will shed some light into a doula’s background and passion in the field. It’s a favorite of ours because it gives doulas the chance to share what they love about this work, which can help you see whether you click with her.

 

  1. What would you say your doula style is?

 

Asking about a doula’s style will allow them to showcase their strengths. You may want an upbeat cheerleader, a joke cracker, or more of a soft-spoken encourager. Just like anybody else, doulas have personality attributes that make them stand out, and that may be better suited for some people rather than others. Their energy will set the tone for your labor experience, so you want to make sure it’s aligned with what you want.

 

  1. How many parents have you been a doula for?

 

It’s great to know how much experience a doula has in supporting women through labor. Usually, they need to attend at least three births for certification purposes. A newer doula may charge less, while more advanced doulas who’ve been doing this for years could cost quite a bit more.

 

  1. Do you have experience at the hospital or location where I’m giving birth? Have you worked with my OB before?

 

This question can help validate whether and to what degree they’ll be able to navigate the environment you’re in like a pro, and give you the inside scoop on what to expect.

 

  1. What are some ways you prefer to support mothers giving birth?

 

This is a good way to understand how much and how long you’ll be in contact with your doula before, during, and after birth. You’ll also find out more about her “style” and how she specializes in support. Some doulas may be more education heavy, while others might focus more on physical touch for pain relief or emotional support as a shoulder to cry on.

 

  1. Have you done any continued education since your initial doula training?

 

With the amount of education and extended trainings available, it’s great to know if your candidates offer any additional expertise or approaches.

 

  1. What are your rates?

 

The fees for doulas vary depending on experience, training, and the city you live in, so there’s really no one standard. It can fall anywhere between $300 to $2,000, depending on where you live and how long they’ve been doing this.

 

  1. Do you use any special approaches to labor pain?

 

There are so many coping and relaxation methods that help laboring moms through the birth process in a positive and empowering way. Many women have reported that having a doula reduced the need for pain medication, so it’s great to know the specific techniques your candidates use.

 

  1. What are your thoughts on C-sections?

 

There’s no wrong way to give birth, and doulas should support all types of labor. If your labor ends up as a cesarean birth, your doula should remain a supportive and calming force.

 

  1. Do you have a backup doula?

 

Remember: Sometimes babies have their own schedules. Ask doulas how they’ve handled missing births (or near-misses) in the past, and what happened. Doulas may work with specific birth partners who serve as backups. If she does, ask how she chose her backup and what that doula’s style and demeanor is like. You should ask to meet with them, too. If they don’t have a backup, figure out if you can get comfortable with that.

 

 

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How my own adoption alienates me from pregnancy

I have two mothers.

 

The one I call Mom has cared for me from the time I was three months old. She ferried me to school, nursed me when I was sick and cooked most of our family meals until I left for university. I only spent the first few weeks of my life with my biological mother. And now that I’m an adult, I realize that my experience as an adoptee has affected me in a way I didn’t really expect: it severely alienated me from pregnancy.

 

 

Many women reach a point in adulthood excited about the prospect of having a baby – imagining their burgeoning baby bumps and the cozy nesting phase of turning studies into nurseries. But not me. Instead, I worry about how I will cope with carrying a child, because I have no memories of being carried.

 

In high school, I remember my best friend’s mom joking about how one of her children stubbornly sat in her womb, feet pointed downwards – not great for birthing. After marriage, I saw photos of my mother-in-law during her pregnancy, happily expecting. But where others hear fond memories from their families about the exciting time just before they were born, I feel a void around my conception and time in my mother’s belly.

 

I am not looking for other women’s anecdotes to replace my biological mother’s experience because nothing can replace my birth story. And I never learned about my biological mother’s quirky cravings, the harrowing drive to the hospital, or how I triumphantly emerged into the world. (The lone detail I learned from the adoption agency wasn’t romantic in the slightest: I gave my mother relentless back cramps before delivery.)

 

Although I have enjoyed much good fortune, the beginning of my life was tainted with pain. For my biological parents, my newfound existence was the opposite of a joyful miracle; I was a “dirty little secret” that brought shame on the family. My young biological parents, heavily influenced by their own parents, decided to place into me into a loving adoptive family before I was born. During the later stages of pregnancy, my stressed biological mother retreated from society to an adoption agency, where she eventually gave birth to me.

 

So while l want to have children of my own some day, I want them to be born in circumstances very different from my own. I imagine it like this: my husband and I delightedly gawking at the positive pregnancy test, us quietly sharing the news with our family and closest friends, me complaining about my changing body, then laughing, because we are just so thrilled to grow our family.

 

My adoption may make pregnancy more difficult for me, physically and psychologically. However, even though my mom won’t be able to relate to the physical aspects of pregnancy, I know she will bolster my spirits with her sheer enthusiasm. (I believe she’s been quietly keen to become a grandmother for some time, but mercifully hasn’t prodded me to bring a child into the world before I’m ready.) And her enthusiasm is the most vital information I learned from the adoption agency, as I read her handwritten note, requesting another update and more photos of me when painfully slow snail mail was the only option.

 

When the time comes for me to have a baby, I won’t have a bona fide pregnancy guide, but I’m going to jump into my way – with the full support of my parents and my partner.

 

 

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Breastfeeding help, tips, and support for new moms

Despite breastfeeding’s reputation as the “natural” way to feed babies, it doesn’t always come naturally to new moms and babies. It takes some patience, time, and trial and error to discover what works best for you. After all, it’s a new skill for both of you! In some cases, that could mean solely breastfeeding, exclusively pumping, supplementing with bottle feeding, or formula feeding, or even some combination of those. At Motherfigure, we believe fed is best (no matter how), but if you need breastfeeding help, we’ve got resources for that, too.

 

Research has shown that mother’s milk can benefit babies in their growth, development, and overall health. It may also lower the chances of certain illnesses. Northwestern Medicine advises that babies should be fed with breast milk for their first six months of life, and ideally up to the infant’s first birthday.

 

grayscale photo of woman carrying a baby

 

Breastfeeding support in the hospital

 

After a baby is born, postpartum nurses will help monitor the mother and baby’s health and share tips about transitioning into life with a newborn. Your nurses are trained to offer some guidance on getting your first (or fifth) latch.

 

Most hospitals have lactation counselors on staff who will pay a visit to help and guide new mothers as they learn how to nurse the newborn. They’ll check your latch, offer tips on breastfeeding positions, and strategically encourage the newborn to latch onto the breast. (Be warned: They might get handsy.)

 

They have in-depth training to help mothers learn the best breastfeeding methods, and they help with difficult nursing situations, such as breastfeeding premature infants, breastfeeding twins or triplets, breastfeeding babies with medical conditions, or ineffective breastfeeding.

 

Breastfeeding help and tips for improving your breast milk supply

 

The reality for most of us is that your breast milk won’t come in for several days, the very days when you’re trying to get the hang of this thing by nursing your baby on colostrum. That’s expected, which is why doctors expect that newborns will lose up to 10 percent of their birth weight in their first days of life. Try not to panic in these early days. Your breast milk supply isn’t there yet, and it isn’t supposed to be.

 

But plenty of women have low milk supply in general, and there are tips for increasing supply.

 

  • Nurse the baby often. This is your best bet, as breast milk is a supply-and-demand function, so if your body perceives greater demand, it’ll get biological cues to produce more
  • Breastfeed for 10 to 15 minutes per breast to be sure you stimulate milk production
  • Breastfeed using both breasts each time
  • Switching between breasts during feedings helps to keep tired babies who need to eat awake
  • Rest as much as possible, and try to get into a relaxed state before breastfeeding. Rushing or worrying can make it more difficult.
  • Be sure your baby is properly latched on, to supply pressure underneath the areola on the milk reservoirs
  • At every feeding, drink a large glass of water
  • Incorporate more veggies and protein into your diet
  • Pump for a few minutes an hour after breastfeeding until the supply stops—that way, even when baby isn’t feeding, you’re telling your body to ramp up that supply!

 

If you’re still struggling with supply, there are products on the market called galactagogues, substances that purport to increase milk supply.

 

Try reaching out to a lactation consultant who can offer additional guidance. Your local milk bank may also have milk available for you to supplement. And remember—there’s no right way to feed YOUR baby, so long as your baby is being nourished. Some women choose to exclusively pump. Some women turn to the solution of formula. And some keep at breastfeeding with help.

 

Dealing with sore nipples from breastfeeding

 

Friction is common, especially in the early days. It tends to happen when your baby isn’t latched on properly, latching to the nipple and not the areola, leading to sensitive and sore nipples.

 

Irritation of the nipples can also be caused by moisture from leaking milk or wet breast pads.

 

To prevent sore nipples, attempt to use the correct body positioning and latch techniques, breastfeed often, and soften the areola through areolar expression. Use soaps and lotions that are gentle and not drying, and switch up your breastfeeding positions regularly.

 

When your baby is done feeding, remove him or her from your breast carefully, and expel a small amount of milk from your nipples to spread over them. Let it air dry to help calm the skin. Also be sure to change your bra liners anytime they get wet to avoid irritation.

 

If you experience intense pain, there are certain relief techniques you can practice:

  • Start feeding on the less sore breast first because usually they’ll be more hungry and forceful at first
  • You can also try breastfeeding more often but for shorter periods of time. Icing the areola and nipple prior to breastfeeding can help with tenderness, as well
  • Keep your nipples dry, remove your bra at home, wear loose clothes, and apply a moisturizer like Aquaphor to the nipples

 

If you’re experiencing more serious pain, such as from a clogged duct, take measures to ensure that it doesn’t develop into mastitis. 

 

 

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