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Exclusive Q&A with Rebecca Dekker – What Does the Evidence Say about Induction for Going Past your Due Date?

April 15th, 2015 by avatar

What does the evidence say about dueToday on Evidence Based Birth, occasional contributor Rebecca Dekker, Phd, RN, APRN, provides a comprehensive research review –  Induction for Going Past your Due Date: What does the Evidence Say?  I had an opportunity to preview the article and ask Rebecca some questions about her most recent project on due dates. I would like to share our conversation here on Science & Sensibility with all of you. Rebecca’s website has become a very useful tool for both professionals and consumers to read about current best practice.Consumers can gather information on the common issues that they maybe dealing with during their pregnancies. Professionals can find resources and information to share with students and clients.  How do you cover the topic of inductions at term for due date?  After reading today’s S&S post and Rebecca’s research post, do you think you might share additional information or change what you discuss?  Let us know in the comments section.- Sharon Muza, Community Manager, Science & Sensibility.

Note: if the Evidence Based Birth post is not up yet, try again in a bit, it should be momentarily.

Sharon Muza: Why did you decide to tackle the topic of due dates as your next research project and blog post?

Rebecca Dekker: Last year, I polled my audience as to what they would like me to write about next. They overwhelmingly said that they wanted an Evidence Based Birth article about Advanced Maternal Age (AMA), or pregnancy over the age of 35. As I started reviewing the research on AMA, it became abundantly clear to me that I had to first publish an article all about the evidence on due dates. This article on induction for due dates creates a solid foundation on which my readers can learn about induction versus waiting for spontaneous labor in pregnant women who are over the age of 35.

SM: When you started to dig into the research, were there any findings that surprised you, or that you didn’t expect?

RD: There were two topics that I really had to dig into in order to thoroughly understand.

The first is the topic on stillbirth rates. I began to understand that it’s really important to know which mathematical formula researchers used to calculate stillbirth rates by gestational age. It was interesting to read through the old research studies and letters to the editors where researchers argued about which math formulas were best. In the end, I had to draw up diagrams of the different formulas (you can see those diagrams in the article) for the formulas to make sense in my head, and once I did, the issue made perfect sense!

Before 1987 (and even after 1987, in some cases) researchers really DID use the wrong formulas, and it’s kind of funny to think that for so many years, they used the wrong math! In general, I thought the research studies on stillbirth rates by gestational age were really interesting…it raised questions for me that I couldn’t answer, like why are the stillbirth rates so different at different times and in different countries? Also, it was really clear from the research that stillbirth rates are drastically different depending on whether you are looking at samples that include or don’t include babies who are growth-restricted.

The other big breakthrough or “ah ha” moment I had was when I finally realized the true meaning of the Hannah (1992) Post-Term study. There was such a huge paradox in their findings… why did they find that the expectant management group had HIGHER Cesarean rates, when clinicians instinctively know that inductions have higher Cesarean rates compared to spontaneous labor? Since all of the meta-analyses rely heavily on the Hannah study, I knew I needed to figure this problem out.

There are a couple different theories in the literature as to why there were higher C-section rates in the expectant management group in Hannah’s study. One theory is that the induction group had Prostaglandins to ripen the cervix, while the expectant management group did not. However, in a secondary data analysis published by Hannah et al. in 1996, they found that this probably played just a minor role.

Another theory is that as women go further along in their pregnancy, physicians get more nervous about the risk of stillbirth, and so they may be quicker to recommend a Cesarean in a woman who is past 42 or 43 weeks, compared to one who is just at 41 weeks. This theory has been proposed by several different researchers in the literature, and there is probably some merit to it.

But in the end, I found out exactly why the C-section rates are higher in the expectant management group in the Hannah Post Term study (and thus in every meta-analysis that has ever been done on this topic). Don’t you want to know why? I finally found the evidence in Hannah’s 1996 article called “Putting the merits of a policy of induction of labor into perspective.” The data that I was looking for were not in the original Hannah study… they were in this commentary that was published several years later.

dekker headshotThe reason that Cesarean rates were higher in the expectant management group in the Hannah study is because the women who were randomly assigned to wait for spontaneous labor, but actually ended up with inductions, had Cesarean rates that were nearly double of those among women who had spontaneous labor. Some of these inductions were medically indicated, and some of them were requested by the mother. In any case, this explains the paradox. It’s not spontaneous labor that leads to higher Cesarean rates with expectant management… the higher Cesarean rates come from women who wait for spontaneous labor but end up having inductions instead. 

So the good news is that if you choose “expectant management” at 41-42 weeks (which is a term that I really dislike, because it implies that you’re “managing” women, but I digress), your chances of a Cesarean are pretty low if you go into spontaneous labor. But if you end up being one of the women who waits and then later on chooses to have an induction, or ends up with a medically indicated induction, then your chances of a Cesarean are much higher than if you had just had an elective induction at 41 weeks.

SM: What information do you recommend that childbirth educators share to help families make informed decisions about inductions and actions to take as a due date comes and then even goes, and they are still pregnant.

RD: First of all, I think it’s important for all of us to dispel the myth of the 40 week due date. There really is no such thing as a due date. There is a range of time in which most women will go into labor on their own. About half of women will go into labor by 40 weeks and 5 days if you’re a first-time mom (or 40 weeks and 3 days if you’ve given birth before), and the other half will go into labor after that.

The other thing that it is important for childbirth educators to do is to encourage families—early in pregnancy—to talk with their health care provider about when they recommend induction, and why.

There are some health care providers who believe strongly that induction at 39, 40, 41, or 42 weeks reduces the risk of stillbirth and other poor outcomes. There are parents who have the same preference. Then there are other health care providers who believe strongly that induction for going past your due date is a bad thing, and shouldn’t be attempted unless there are clear medical reasons for the induction. And there are parents who will tend to share that same preference. Either way, parents need accurate information about the benefits and risks of waiting versus elective induction at 41-42 weeks—because both are valid options.

But it’s probably best to avoid a mismatch between parents and providers. If parents believes strongly that they want to wait for spontaneous labor, and they understand the risks, but they have a care provider who believes strongly in elective induction at 41 weeks, then they will run into problems when they reach 41 or 42 weeks and their care provider disagrees with their decision.

Clearly, there are benefits to experiencing spontaneous labor and avoiding unnecessary interventions. But at the same time there is a rise in the relative risk of stillbirth starting at about 39 weeks, depending on which study you are looking at. However, the overall risk is still low up until 42 weeks. At 42 weeks, the risk of stillbirth rises to about 1 in 1,000 in babies who are not growth-restricted. The risk may be higher in some women who have additional risk factors for stillbirth. Women who experience post-term pregnancy (past 42 weeks) are more likely to experience infections and Cesareans, and their infants are more likely to experience meconium aspiration syndrome, NICU admissions, and low Apgar scores.

SM: Would you recommend that families have conversations about how their due date is being calculated, at the first prenatal with their health care providers. What should that conversation include?

RD: I would recommend asking these questions:

  • What is the estimated date range that I might expect to give birth—not based on Naegele’s rule, but based on more current research about the average length of a pregnancy?
  • Did you use my Last Menstrual Period or an early ultrasound to determine my baby’s gestational age?
  • Has my due date been changed in my chart at any point in my pregnancy? If so, why?

SM: The concept of being “overdue” if still pregnant at the due date is firmly ingrained in our culture. What do you think needs to happen both socially and practically to change the way we think about the “due date?”

RD: We need to start telling everyone, “There is no such thing as a due date.” To help women deal with the social pressure they may experience at the end of pregnancy, I’ve created several Facebook profile photos that they can use as their Facebook profile when they get close to their traditional “due date.” To download those photos, visit www.evidendebasedbirth.com/duedates

SM: How available and widely used are first trimester ultrasounds? If first trimester ultrasounds were done as the standard of care in all pregnancies, would it result in more accurate due dates and better outcomes? Do you think there should be a shift to that method of EDD estimation?

RD: I think the option of having a first trimester ultrasound definitely needs to be part of the conversation between a woman and her care provider, especially because it has implications for the number of women who will be induced for “post-term.” I could not find any data on the percentage of women who have an ultrasound before 20 weeks, but in my geographic area it seems to be nearly 100%, anecdotally.

If your estimated due date is based on your LMP, you have a 10% chance of reaching the post-term period, but if it’s based on an early ultrasound, you only have a 3% chance of reaching 42 weeks.

One strange thing that I noted is that ACOG still prefers the LMP date over an early ultrasound date. They have specific guidelines in their practice bulletin about when you need to switch from the LMP date to an ultrasound date, but the default date is still the LMP. I found that rather odd, since research is very clear that ultrasound data is more accurate than the LMP, for a host of reasons!

Before I published the due dates article, I reached out to Tara Elrod, a Certified Direct Entry Midwife in Alaska, to get her expert feedback as a home birth midwife. She raised an excellent point:

“It is of significant interest to me as a licensed midwife practicing solely in the Out-of-Hospital setting that ultrasounds done in early pregnancy are more accurate than using LMP. If early ultrasound dating was achieved, it’s thought that this would ultimately equate to less women being induced for post-term pregnancy. This is significant to midwives such as myself due to the scope-of-care regulation of not providing care beyond 42 weeks. While an initial- and perhaps arguably by some ‘elective’ ultrasound-  may not be a popular choice in the midwife clientele population, a thoughtful risk versus benefit consideration should occur, as to assess the circumstance of “risking out” of care for suspected post-dates. [In my licensing state, my scope of care is limited to 37+0 weeks to 42+0 weeks, with the occasional patient reaching 42 weeks and therefore subsequently “risking out,” necessitating a transfer of care.]” ~Tara Elrod, CDM

SM: What do you think the economic cost of inductions for due dates is? The social costs? What benefits might we see if we relied on a better system for determining due dates and when to take action based on being postdates?

RD: There are economic costs to both elective inductions and waiting for labor to start on its own. The Hannah Post-Term trial investigators actually published a paper that looked at the cost effectiveness of their intervention, and they found that induction was cheaper than expectant management. This was primarily because with expectant management, there were extra costs related to fetal monitoring (non stress tests, amniotic fluid measurements, etc.) and the increased number of Cesareans in the expectant management group.

But there are many unanswered questions about the cost-effectiveness of elective induction of labor versus waiting for labor to begin (with fetal monitoring), so I’m afraid I can’t make any definitive statements or projections about the economic and social costs of elective inductions. Here is a study that may be of interest to some with further information on this topic.

I do know that in a healthy, low-risk population, birth centers in the National Birth Center Study II provided excellent care at a very low cost with women who had spontaneous births all the way up to 42 weeks. I would love to see researchers analyze maternal and neonatal outcomes in women stratified by gestational age in the Perinatal Data Registry with the American Association of Birth Centers.

 SM: I very much look forward to all your research posts and appreciate the work  and effort you put into doing them. What is on your radar for your next piece?

RD: The next piece will be Advanced Maternal Age!! After that, I will probably be polling my audience to see what they want, but I’m interested in tackling some topics related to pain control (epidurals and nitrous oxide) or maybe episiotomies.

SM: Is there anything else that you want to share about this post or other topics?

RD: No, I would just like to give a big thank you to everyone who helped in some way or another on this article!! There was a great interdisciplinary team who helped ensure that the due dates article passed scrutiny—we had an obstetrician, family physician, nurse midwife, several PhD-prepared researchers, and a certified direct entry midwife all provide expert review before the article was published. I am so thankful to all of them.

References

Hannah, M. E., C. Huh, et al. (1996). “Postterm pregnancy: putting the merits of a policy of induction of labor into perspective.” Birth 23(1): 13-19.

Hannah, M. E., W. J. Hannah, et al. (1992). “Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.” N Engl J Med 326(24): 1587-1592.

 

 

 

Cesarean Birth, Childbirth Education, Evidence Based Medicine, informed Consent, Maternal Quality Improvement, Maternity Care, New Research, Research , , , , ,

Because… A Poem Honoring Cesarean Awareness Month

April 9th, 2015 by avatar

CAM 2015 GBWCGiving Birth with Confidence is the sister blog to Science & Sensibility, Lamaze International and is geared for parents and new families.  Cara Terreri, ( you may remember Cara, we followed her journey to becoming an LCCE) has been the Community Manager there since the blog was first established in 2008.  I always point the families in my classes to Giving Birth with Confidence because I know that they will find evidence based information along with great inspiration to push for a safe and healthy birth.

Cara recently wrote and published a poem on Giving Birth With Confidence to commemorate Cesarean Awareness Month (April), and it really spoke to me.  Since April is also National Poetry Month, I wanted to share her poem with you, in hopes that you might pass on and share with the families you work with.  Because 1 in 3 is too many.

Because…

1 in 3 is too many

Recovery is hard

My birth was still a birth

I want to have a VBAC

My scar still hurts

I was separated from my baby

My doula supported me in the OR

I didn’t have a choice

I got to experience skin to skin with my baby right away

I made the choice this time

I wish I would have known

I feel cheated

My doctor never told me this could happen

It’s going to be OK

My sister said this was easier anyway

My midwife made the right decision to transfer to the hospital

Friends told me at least I had a healthy baby

I have postpartum depression

It was the best decision for my birth

My husband has scars too

I’m embarrassed

My doula wasn’t allowed back into the OR

I failed the one thing I’m supposed to be able to do as a woman

My mom had one too; I guess it was meant to happen

I know my doctor helped me make the best decision

I want more for my daughter

I am a source of courage and support for others who have gone before me and those who will go after me

I did the best that I could with the knowledge I had at the time

I’m doing better now

My baby is beautiful

My body is strong

I am resilient

My birth matters

By Cara Terreri

cara headshot

 

Cesarean Birth, Childbirth Education, Depression, Giving Birth with Confidence, Guest Posts, Infant Attachment, Newborns , , , , , ,

New Webinar for Birth Pros: “Making It Work! – Breastfeeding Tips for the Working Mom”

March 24th, 2015 by avatar
breastfeeding working mother

flickr.com/photos/jennysbradford/4356862824

I often share in childbirth classes that breastfeeding can be the next big challenge after birth.  As a childbirth educator, I weave breastfeeding information throughout my class series. By the time the “breastfeeding” part of the class happens towards the end of the series, the families are eager and ready to learn how to be as prepared as possible to feed their baby, without actually having baby there yet to “practice” with.

I provide additional follow up resources for the families as well, including where to get help locally with breastfeeding issues, what current best practice says on a variety of breastfeeding topics and useful videos like effective hand expression.  Returning to work and breastfeeding is one topic that I feel is important to cover, but often gets short shrift due to lack of time. Families don’t even have their babies in their arms yet, and the “return to work” point still seems very far off, and I have a lot of information to share in a short class time. In some areas, there are specific classes that families can attend that specialize in the “breastfeeding for the working parent” topic, but not many families can locate or take advantage of this type of class.

I would love to be able to support my families long after their childbirth education class is over with information they can use and apply for the working/breastfeeding parent, and that is why I am planning on attending Lamaze International’s free (non-Lamaze members $20) 60 minute webinar “Making It Work! Breastfeeding Tips for the Working Mom” offered on March 26th at 1:00 PM EST.

It is well documented that exclusive breastfeeding rates drop significantly when women return to work or school.  There are many barriers to overcome and prenatal information and support can help families to prepare for the time when babies are being cared for by others and still being breastfed.  This online webinar is appropriate for doulas, childbirth educators, lactation consultants, nursing staff, physicians and midwives.

The webinar is being presented by Patty Nilsen, RN, BSN, BA, IBCLC, ANLC.  Patty is an Outpatient Lactation Consultant for Mount Carmel East, West & St. Ann’s Hospitals in Columbus, Ohio, where she provides daily private outpatient lactation consultation for women experiencing challenges and in need of encouragement with breastfeeding, leads weekly breastfeeding support groups, and answers over 300 breastfeeding helpline calls per month.  Patty has learned many innovative tips for returning to work and breastfeeding from the thousands of mothers she has worked with over the years and is eager to share them in this webinar.

© womenshealth.gov

© womenshealth.gov

The webinar is open to all, and Lamaze International members are able to attend at no cost.  Non-members will pay $20 at registration to participate.  Additionally, this workshop has been approved for continuing nursing education hours which  are accepted by DONA, Lamaze, ICEA and other birth professional organizations. The cost for receiving continuing education hours for Lamaze members is $35 and for non-members is $55, (which includes the cost of the webinar). As mentioned above, Lamaze members attend for free, if they are not enrolled for the contact hours.  Contact hours are awarded after completing the webinar and a post-webinar evaluation. CERPS are pending.

You can register for the webinar (select contact hours or no-contact hours) at this link – and then prepare to join on Thursday at 1:oo PM EST.  After the webinar, come back and share your top takeaways and how you are going to use this information to support families in your area with other Science & Sensibility readers.

Babies, Breastfeeding, Childbirth Education, Lamaze International, Webinars , , , , , , ,

Birth By The Numbers Releases New Video – Myth and Reality Concerning US Cesareans

March 19th, 2015 by avatar

birth by numbers header

I have been a huge fan of Dr. Eugene Declercq and his team over at Birth by the Numbers ever since I watched the original Birth by the Numbers bonus segment that was found on the Orgasmic Birth DVD I purchased back in 2008.  I was on the board of REACHE when we brought Dr. Declercq to Seattle to speak at our regional childbirth conference in 2010 and since then have heard him present at various conferences around the country, including most recently at the 2014 Lamaze International/DONA International Confluence, where Dr. Declercq was a keynote speaker.  I enjoy listening to him just as much now as I did back in 2008.  You  may also be familiar with Dr. Declercq’s work as part of the Listening to Mothers research team that has brought us three very valuable studies.

Birth by the Numbers has grown into a valuable and up to date website for the birth professional and the consumer, filled to the brim with useful information, videos, slide presentations and blog posts.  This past Tuesday, the newest video was released on the website: Birth By The Numbers: Part II – Myth and Reality Concerning US Cesareans and is embedded here for you to watch.  We shared Part I in a blog post last fall.


Also available for public use is a slide presentation located in the the “Teaching Tools” section of the Birth by the Numbers website designed to provide additional information, maps, data and resources for this new Myths and Reality Concerning Cesareans video. Included in this slideshow are notes and updates to help you understand the slides and share with others.  This material is freely given for your use.

© Birth by the Numbers

© Birth by the Numbers

This video explores how cesareans impact maternity care systems in the USA.  After watching the video and reviewing the slides, here are some of my top takeaways.

1.  The common reasons given for the nearly 33% cesarean rate in the USA (bigger babies, older mothers, more mothers with obesity, diabetes and hypertension, more multiples and maternal request) just don’t hold water when examined closer.

2. Many women feel pressure from their healthcare provider to have a cesarean, either prenatally or in labor.

3. The leading indicators for cesareans are labor arrest (34%) and nonreassuring fetal heart tracings (23%).

4. The rise in cesareans is not a result of a different indications.  Dr. Declercq quotes a 20 year old article’s title that could still grace the front pages today. “The Rise in Cesarean Section Rate: the same indications – but a lower threshold.”

5. When examining the distribution of cesarean births by states over time, it is clear that those states with the highest cesarean birth rate decades ago, still remain in those spots today.

6. “We are talking about cultural phenomena when we are talking about cesareans, not just medical phenomena.”

7. First time, low risk mothers who birthed at term and experienced labor had a 5% cesarean rate if they went into spontaneous labor and did not receive an epidural.  If they were induced and received an epidural, the cesarean rate was 31%.

8. The United States has the lowest VBAC rate of any industrialized country in the world.

© Birth by the Numbers

© Birth by the Numbers

While the video is rich (and heavy) in data laden charts and diagrams, the message, though not new, is clear.  The US maternity care system is in crisis.  We have to right the ship, and get back on course for healthier and safer births for pregnant people and babies. Take a look at this new video, and think about what messages you can share with the families you work with and in the classes you teach, to help consumers make informed choices about the care they receive during the childbearing year.

Please watch the video, visit the website to view the slides and let me know here in the comments section what you are going to use from this information to improve birth.

Babies, Cesarean Birth, Childbirth Education, informed Consent, Maternal Obesity, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research , , , ,

Thanks IBCLCs – For Helping New Families Meet Their Breastfeeding Goals

March 5th, 2015 by avatar

IBCLCDayLogo 2015(2)Yesterday was IBCLC Day – a special day set aside once a year to recognize the hard work and efforts that International Board Certified Lactation Consultants provide all all year long in support of breastfeeding for mothers, babies and really, the entire family.  IBCLC Day is sponsored by the International Lactation Consultant Association, a professional organization for IBCLCs around the world.

Becoming an IBCLC is no easy feat; the requirements to become credentialed are very rigorous and involve many clinical hours and an exhaustive exam.  Continuing education hours and/or retaking the exam are required every 5 years to maintain the credentials.  There are over 27,450 IBCLCs worldwide.

Some IBCLCs are also Lamaze Certified Childbirth Educators.  Both organizations represent the gold standard in their field and it is not surprising that some professionals seek out both qualifications.  When an LCCE is also an IBCLC, their class families can really benefit.  The LCCE is able to weave in a rich knowledge of breastfeeding topics and information throughout the class, as well as share information about common challenges that they see when working as an IBCLC.

creative commons licensed (BY-NC) flickr photo by robysaltori: http://flickr.com/photos/robysaltori/4604876371

CC flickr photo by robysaltori: http://flickr.com/photos/robysaltori/4604876371

A lactation consultant can use their childbirth education skills to hone their communication and help families understand the nuances of feeding their babies when they are delivering breastfeeding information during a consultation.  The two professions can complement each other beautifully.

Of course, the scope of practice of LCCEs and IBCLCs is different, and it is important to recognize the separation and to wear the proper hat when conducting yourself professionally in either capacity.

For official information on how to become an IBCLC, check out the information on the International Board of Lactation Consultant Examiners (IBLCE ) site. If you are considering becoming an IBCLC, there is an Facebook Group just for you, where you can discuss the different pathways, find out more about the requirements and costs, and receive the support of other men and women exploring the IBCLC process and preparing for the exam.

I reached out to some Lamaze Certified Childbirth Educators, who are also IBCLCs, to ask some questions and learn more about experience of wearing both hats.  Teri Shilling, Ann Grauer and Ashley Benz generously shared their thoughts below.

Sharon Muza:  Which credential did you receive first, your IBCLC or your LCCE?

Teri Shilling: I received my LCCE first.

Ann Grauer: I was an LCCE first. I never thought I’d be an IBCLC but one year the policies fit me and I decided to go for it.

Ashley Benz: I became an LCCE first and then an IBCLC. My goal had always been to become a lactation consultant. I knew that it was a long road and I was so interested in getting started working with families that I did a couple of certifications before I was ready to take my IBCLC exam.

SM: How does having both credentials benefit your students and clients?

Teri: So much of my work as an IBCLC is education – by the bedside, on the phone, etc.  Keeping things simple and memorable is key.  The certifications speaks to my professionalism and commitment to continuing education

Ann: I had a CLC before my IBCLC—I’ve always felt that I wanted and needed more information on breastfeeding. I’ve taught breastfeeding classes since the beginning but the information explosion in that one topic is incredible!  I feel very strongly that it serves my childbirth classes well that I have that credential and that being an LCCE serves my breastfeeding clients. I see things from a “facilitator of education” standpoint, rather than a traditional IBCLC standpoint.

Ashley: Because a lot of what a lactation consultant does is teach, I use the skills I’ve gained from teaching Lamaze class in breastfeeding consultations. In Lamaze class, I use my knowledge about breastfeeding and mother-infant bonding.

SM: Does your IBCLC knowledge influence how and what you teach about breastfeeding? 

Teri: Yes, I think it does, but I have been an IBCLC for 20+ years and can’t remember what I taught before.  But being an IBCLC gives me first had experience with the big bumps in the road many women hit during the postpartum time.

Ann: Yes. I’ve actually simplified what I teach. Being an IBCLC, means I now appreciate that parents need simple and honest information that they can incorporate into their parenting.

Ashley: I probably emphasize the need to seek proper help more than other educators. My class focuses on the basics of breastfeeding and assumes I’ve convinced my students to get support for issues that arise.

SM: What would you recommend for other LCCEs who might want to be an IBCLC? What are the challenges?

Teri: Do a community search for where the gaps are in support – is there a breastfeeding coalition in your area? It is important to network.  Find a mentor.  I would say go for it.  More education never hurts.  The challenge is being employed as an IBCLC as a non-nurse.  It helps if you are the entrepreneur type and able to set up a private practice.

Ann: If you’re a non-RN you will have to work incredibly hard. The system is set up to be medically-minded and there is not appreciation/understanding of what non-RNs bring to the table. Which, by the way, is a lot. Rather than focusing on becoming an IBCLC, allow yourself to enjoy the journey of learning and you’ll be there before you know it.

Ashley: The major challenge of the IBCLC path is that it can be very time (and often financially) intensive. I recommend checking out the IBLCE website and see if there is a pathway that you already fit into. If not, make a five-year plan to become an IBCLC.

SM: Where do you think it gets tricky wearing both hats?

Teri: I don’t think it does.  I love being able to be part of the continuum from pregnancy to postpartum.

Ann: I don’t think it does. My confidence is in the mother and baby. I’m just here to help in any role I can.

Ashley: Whenever you have multiple sets of skills, it can be difficult to maintain appropriate business boundaries and communicate those to your students and clients.

Careers as both a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant are fun, challenging and very rewarding.  They are a wonderful compliment to each other and families can benefit from the knowledge that someone who holds both credentials can share when serving in either role.  Are you an LCCE who has considered or would like to become an IBCLC?  Are you already on that path?  Share a bit about your journey in our comments section and let us know.

Babies, Breastfeeding, Childbirth Education, Newborns , , , , , , , , ,