Breastfeeding mums can have a variety of people rock up to help in the early days – and in my experience, many parents can be pretty confused as to who’s who and what experience and qualifications they have. This seems like a massive shame to me – personally, if I wanted to learn Italian, I’d want to make sure that my teacher was fluent in the language and had some accepted, recognised qualification in how to teach it – or at least a wealth of on-the-job experience.
And even if the parents aren’t interested (after all, if this lady can help me, I couldn’t care less if she were the Devil in a dress) it seems that many health professionals and doulas need a quick lesson in who we all are, where we come from and what we are qualified ‘to do’.
So this, to the best of my ability, is a quick run down of who’s who in the breastfeeding world. If you spot any mistakes or ommissions, please take a moment to correct me! I know a bit about BfN and ABM but less about LLL and NCT and am not a midwife or health visitor or any other kind of health professional, so the following is what I’ve picked up along the way.
La Leche League (LLL)
LLL was founded in the US in 1956 and has grown worldwide in the intervening years. It is a voluntary organisation run by mothers, for mothers. LLL Leaders learn by working with their local group, with a tutor and home study. LLL Leaders must have breastfed themselves and be willing and able to give to their communities during and after the training. The standard of education is high and Leaders have ample opportunity to debrief from their own experiences, are more than qualified to work with normal breastfeeding, recognise problems and offer suggestions to solve those problems. They are also trained to recognise when to signpost mothers to Health Professionals. LLL expect Leaders to work in their local communities or on the helpline after qualifying.
National Childbirth Trust (NCT)
NCT Train Breastfeeding Counsellors as well as Antenatal Teachers alongside their many other activities. Their training has a reputation for being very academic and rigorous (the qualification is University accredited) and, like the other charitable organisations, Counsellors have a good opportunity for personal growth as well as gaining the knowledge and skills to support parents in their breastfeeding journey. Those wishing to access training are expected to engage with their local NCT group before, during and after training. University fees apply for the training, but some burseries and student loans are available.
Breastfeeding Network (BfN)
BfN’s entry-level course is the Helper Course. This takes 12 weeks of weekly tutorials and home study. Helpers are ‘well-informed friends’ and considered the equivalent to what others may call a ‘peer supporter’. Helpers can then move on, if they wish, to the Supporter Course which can take up to 2 years to complete (in line with the other organisations) due to the depth of knowledge, skills and personal growth necessary. BfN’s qualifications are accredited by Open College Network. Training incurrs little cost for the applicant, but it is expected that are, or have been, nursing mothers themselves and that they will volunteer in their local communities once qualified. Training is usually face to face in small tutor groups.
Association of Breastfeeding Mothers (ABM)
ABM is another charitable, voluntary organisation formed 30-odd years ago in the UK. Their entry level course is the Mother Supporter Course, usually done as distance learning with the support of a tutor available by phone/email. The course is sometimes taught face to face by an ABM tutor in group settings. Mother Supporters can apply to Breastfeeding Counsellor training, which comprises a number of modules that the trainee works through at home. ABM also have courses available that have a fee attached so that women who wish to train can access this education if they don’t fit the usual entry criteria.
Whilst the women who train with these organisations are not health professionals, we are trained to be able to support mothers through all manner of challenges to breastfeeding, learn high quality communication and counselling skills, understand our boundaries and work as a member of a team with the relevant health professionals.
All 4 organisations insists on annual re-registration, supervision and constant continuing education, updates and on-going learning.
You should not pay for help from a woman wearing a badge from one of the charitable organisations above. This support is set up to be free at the point of contact. Some breastfeeding supporters receive payment, for example, from Children’s Centres or the NHS to run breastfeeding clinics, drop-ins or groups.
Some trained breastfeeding supporters are also doulas or in private practice in other, related roles. They should always explain very clearly to you what ‘hat’ they are wearing and what you can expect to receive from them according to the role and the service they are providing you.
Peer Supporters have been trained in a variety of ways and have various titles, but the idea is pretty universal: take mothers who have breastfed (or who are currently nursing their children), give them so solid, facts about breastfeeding, bust some of the myths, practice some basic skills of helping mums achieve comfortable breastfeeding and make sure they know how to signpost on. Then let them loose on the community and watch those friendships blossom! Peer Supporters are ‘well-informed friends’ and need to be well supported and encouraged to continuing their learning journey if they want to – in other words, today’s Peer Supporters are tomorrow’s Counsellors if they are properly nurtured and respected.
If they are trained by the ABM they will be called Mother Supporters.
If they are trained by the BfN, they will be called Helpers
NCT, NHS etc will probably all call them Peer Supporters, but I’ve all sorts of terms, like ‘Buddies’, for example.
All Peer Supporters, Counsellors, Leaders and Supporters are trained to recognise when to signpost parents on to health professionals. We are constantly encouraged to reflect on our boundaries and to work in partnershop with midwives, health visitors and GPs.
All 4 of the breastfeeding support organisations run helplines and, in addition, there is currently a helpline funded by the Department of Health, staffed by volunteers from ABM and BfN.
National Helpline: 0300 100 0212
ABM: 0300 330 5453
BfN: 0300 100 0210
LLL: 0845 120 2918
NCT: 0300 330 0771
BfN line in Bengali / Sylheti: 0300 456 2421
BfN line in Tamil, Telugu and Hindi 0300 330 5469
Drugs In Breastmilk Helpline 0844 412 4665
All lines are staffed by qualified Counsellors/Leaders/Supporters and will be answering the calls in their own home. So I suggest cycling through the numbers til someone picks up – as you can imagine, the volunteers want to give you their full and undivided attention, so will not pick up if the saucepans are boiling over or the children are fighting! Many parents worry that breastfeeding problems couldn’t be helped over the phone. In fact there is a lot you can do just listening and making suggestions and the volunteers have worked long and hard on finding the most effective ways to describe things so that you can work your problem or question through.
Midwives and Health Visitors
Many midwives are very skilled at breastfeeding support. Many have trained with one of the organisations above; others have picked up a lot of wisdom and skill along the way. Sadly, midwives don’t generally have much opportunity to debrief from their own breastfeeding experiences during their training. Some may not have breastfed their own children. Some of the most amazing breastfeeding supporters I know didn’t breastfeed, though, so that shouldn’t undermine your faith in a midwife who knows her stuff. However, some do pass on advice that might have worked for them, but isn’t evidence-based, or believe certain things about breastfeeding or formula because they are advising you based on their own experience. If your local hospital is accredited by the Baby Friendly Hospital Initiative, all health care workers who care for mothers and babies should have received a certain amount of additional training in breastfeeding – roughly equivalent to peer support training.
Health/Maternity Care Assistants
Some of these are great too – they may have lots of experience, knowledge and skill. However, they may also have next to nothing.
GPs may have educated themselves. When it comes to training, as far as I can find out, medical school includes a little about the anatomy of the lactating breast and not much more. The Baby Friendly Initiative and the Voluntary Breastfeeding Organisations are trying to address this unfortunate state of affairs.
All doulas who have done a Doula UK approved Initial Preparation Course will have a very basic grounding in breastfeeding – some simple techniques to help you latch your baby, for example, and lots of signposts to your local breastfeeding support services. We all have differing levels of skills and experience, so do ask your doula. Some will have trained with one of the Voluntary Orgs above, others will have learnt a lot over the years by on-going learning from study days, reading, internal courses provided by Doula UK-approved Trainers and lots of working with mothers (our best teachers, whatever our training!!)
International Board Certified Lactation Consultants (LCs)
This qualification should be the gold standard of breastfeeding education. LCs have either come up through one of the Voluntary Breastfeeding Organisations or is (or was) a Health Professional. Applicants must have a certain number of hours working with breastfeeding mothers and their babies under their belts, have a large amount of formal breastfeeding (and health-related) education and then have to sit an exam. They must resit the exam every few years as well as commit to continuing professional development. LCs are either working within the NHS or in private practice (or both) and are often the magical panacea for the more difficult, entrenched or challenging breastfeeding problems. LCs are generally angels who can rescue even the most depressed and hope-less mothers and many are now training to be able to divide tongue-ties, thereby saving even more breastfeeding relationships. To find a tongue tie divider, please see http://www.tongue-tie.org.uk/
Recent events have eroded my faith in the International Board of Lactation Consultant Examiners somewhat. See my article here.
In reality, whatever your breastfeeding supporter’s origins, please remember that we all have different amounts and different types of experience. Education, however wonderful, only gets you to a place where you begin to realise how much you don’t know! It is only by working with parents for many years and continuing to learn from our colleagues that we begin to hone our skills.
And of course, a big proportion of the work we do is about mothers’ (and fathers’) emotions, preconceptions, family, social and cultural contexts and histories. Mothers may have unresolved emotional issues from the birth or pregnancy that they are still dealing with and there may be worries about the baby as well as often physical pain the mum may be dealing with. This all takes tact, loving care and high quality counselling skills – and we can’t get it right every time – we’re human and we’re all still learning every day.
I look forward to hearing if this has answered any of your questions, or if you can clarify any of my descriptions – or even if you disagree with me!