How you can support normal breastfeeding, even if you don’t have medical training
A postpartum professional who isn’t medically trained needs to be careful about providing advice during or after a breastfeeding assessment. It is not within their scope to provide medical advice.
However, most breastfeeding situations don’t require medical advice. The majority of the breastfeeding problems the typical professional comes across can be solved by adjusting positioning or latch, providing resources, or even just reassuring the parent that things are normal.
If you don’t have a medical background or time to become an Internationally Board Certified Lactation Consultant, this article will outline how non-medical professionals can support normal breastfeeding.
Who can observe and assess a breastfeeding session?
Lactation support is similar to other healthcare roles in that different professionals are qualified to provide different levels of support. It’s important that people working in lactation support understand their scope of practice. This is because giving breastfeeding parents the wrong advice can have a harmful effect.
An IBCLC may perform a clinical assessment of a breastfeed. IBCLC stands for International Board Certified Lactation Consultant. Someone with this qualification has completed a minimum of 90 hours of education in human lactation and breastfeeding, and up to 1000 hours of supervised hands-on clinical experience. They participate in ongoing professional development to maintain their certification, including re-examination at regular intervals.
Doulas, including birth doulas and postpartum doulas, are not typically trained or authorised to perform clinical assessments in a medical or diagnostic sense. However, they can perform a non-clinical assessment and then provide the parents with relevant evidence-based information or referrals to a health professional.
Some doctors and nurses may pursue additional education in lactation independently, but there isn't a universal standard for the amount of dedicated lactation education that general practitioners are required to complete as part of their formal medical education.
In the Postpartum Education and Care Professional training, our students learn how to perform a non-clinical breastfeeding assessment.
What is a non-medical breastfeeding assessment?
A non-medical breastfeeding assessment is a way of gathering information to determine the answer to these questions:
Is baby breastfeeding effectively?
Is the breastfeeding parent having a positive experience?
Ideally, we want the answer to both questions to be yes.
A baby who is breastfeeding well is getting the nutrients they need to grow and thrive. They are working their jaw in a way that supports normal development of the muscles that they will later use for speaking and eating. They’re removing milk from the breast efficiently so that the body receives accurate signals about how much milk this baby requires, and continues to produce the appropriate amount of milk.
From the perspective of the breastfeeding parent, they feel contented, comfortable and confident about their breastfeeding skills. The physical sensations shouldn’t be overwhelming—they may be pleasant or enjoyable. The parent might feel a strong emotional connection towards their baby, perhaps making eye contact or cuddling them. (It’s also normal if this emotional connection isn’t there instantly or constantly).
The person assessing the breastfeeding baby and parent is like a detective. They gather clues and ask questions to get a sense of the full picture. If there’s an issue, they may have to dig deeper to really understand. If there’s a problem, perhaps the person assessing the breastfeed will have to eliminate several possibilities before finding the correct one.
As well as observing the breastfeeding parent and baby, components of a breastfeeding assessment may include asking questions about the mother’s health history, the baby’s health history, the birth and early feeding experiences, and breastfeeding history so far.
In this blog post, we will focus on the breastfeeding observation component.
What does a non-medical breastfeeding assessment look like?
Here are some things we would include in this kind of assessment:
Mother’s facial expression
Is she grimacing or wincing? Is her forehead tight? This can indicate discomfort or pain. Ideally we’d like to see a relaxed facial expression with no tension. Many mothers who are enjoying breastfeeding naturally make eye contact with their babies, or they may have a small smile on their faces.
Baby’s limbs
Are their arms flailing? Are they blocking their access to the breast with their own fist and then shrieking about it? Are they drumming their feet or going stiff as a board? All these signs can indicate a little problem with positioning, usually easily sorted through a readjustment but sometimes requiring further investigation. We’re looking for a fairly calm and still baby, with slow, relaxed movements and fists that gradually relax into open hands at the end of the feed.
The latch
Is baby gripping the nipple with their lips, or is their mouth open wide around the breast? Is the baby's chin touching the breast? Are the baby's lips turned out? Is baby starting with short sucks before starting to suck more deeply?
Mother’s body language
Shoulders up to her ears? Hunched over? Sitting rigidly? Using her forearms or hands to hold baby’s full weight? All of these will leave her with persistent pain and fatigue in the back and arms. She may be stressed without realising it. Even if everything else looks great with the breastfeed, the mother’s body language can be a dead giveaway about her emotional state.
Noises and sounds
The power of listening is often underestimated when it comes to assessing a breastfeed. The sound of gulping air may indicate that baby’s mouth does not have a tight seal around the breast. Baby is sucking in air which may result in a gassy tummy and an unsettled baby. A clicking sound may indicate that a tongue tie assessment is in order. A suck, suck, swallow sound generally means that the letdown has occurred and baby is swallowing milk—excellent!
These are just a few of the things we would focus on during a breastfeeding observation. As mentioned before, we’d also ask the breastfeeding parent some questions to help us form a more comprehensive picture of the situation.
For example, we might ask about the number of wet and soiled nappies/diapers, or about how the mother is feeling towards breastfeeding. We might ask what kind of support they have from household members, or if there’s anything that’s creating unnecessary stress. We’d want to know a bit about baby’s behaviour before and after the feed. We could ask if the mother can feel the letdown, how long it lasts, and if there are any sensations she is curious about.
As you can see, this is really about having a conversation and collaborating with the parent, not just ticking off a checklist.
How to use the results of the non-medical breastfeeding assessment to provide good support
There are many valuable ways non-medical professionals can support normal breastfeeding without giving advice, and we teach all of these in our training! We also teach our students how to spot red flags that breastfeeding is not going normally and who to refer to.
Here are a few concrete examples of what that support might look like:
If the latch doesn’t look right, or the mother says there is pain:
Show the parent videos and images of correct latches
Go through a step-by-step checklist together
Demonstrate strategies using tools like a crocheted breast and mouth puppet, or a doll
If there are red flags that indicate a tongue tie or complex problem provide a referral to an IBCLC who can perform a clinical assessment
If the baby is gagging and spluttering on milk:
Demonstrate laid-back breastfeeding positions
Provide information about hand expressing before starting the feed
Review newborn hunger cues with the parent to ensure they are not waiting too long between feeds and becoming engorged, making it difficult for baby to latch
If the mother believes she has low supply and fears she will be unable to maintain breastfeeding:
Count the number of wet nappies in a 24 hour period
Teach her about supply and demand
Help her outsource any activities or responsibilities that are making it difficult for her to focus on breastfeeding
If the parent feels isolated, criticised or judged by family members who don’t support their breastfeeding journey:
Connect the mother to local support groups
Provide family members with evidence-based information
Help the mother brainstorm ways to set boundaries and communicate her goals effectively
If the mother is breastfeeding twins:
Teach her how to set up pillows and bolsters for maximum comfort so she can feed both twins simultaneously
Show her videos of breastfeeding positions like football hold and upright position
Connect her with breastfeeding support groups and twin support groups to normalise breastfeeding twins and boost her confidence
Can you think of other ways a non-medical postpartum professional can provide valuable support to a breastfeeding parent?
Perhaps you had a difficult start to breastfeeding yourself or know someone who did. Can you imagine the difference it might have made if someone had visited you several times at home and helped you along your journey?
Having this kind of dedicated support in the early days and weeks of postpartum is incredibly important. Most parents in industrialised cultures nowadays are unfamiliar with how breastfeeding works, and there’s a lot of misinformation out there too. Many parents have never held a newborn before their own! So we really need to provide consistent, ongoing, high-quality breastfeeding support to parents in their homes.
If you would like to learn how to provide support for normal breastfeeding, check out Postpartum Education and Care Professional Training. The course includes almost five hours of breastfeeding video reference lessons, also available as transcripts and audio, plus a seven-page Breastfeeding Plan with worksheets and handouts that you can customise with your branding and use with your clients. Find out more about becoming a Postpartum Education and Care Professional here.
