What Does a Doula Need to Know About Lactation?
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Kaely Harrod 00:04
Welcome to doula Tips and Tits. This podcast is a place where we answer one question about doula work, both to support you and to help you support your clients. I'm Kaely Harrod. I've been supporting families in this perinatal space since my oldest was born 12 nearly 13 years ago. I am a birth and postpartum doula childbirth educator, La Leche League Leader and a doula coach. I love guiding and supporting doulas as they work out their doula business. It is a tremendous joy to be trusted in this way. Thank you for joining us on this journey.
Kaely Harrod 00:42
Hello, and welcome back. I have another guest with me today. I'm very excited about my dear friend Tiara who is an ibclc, but also a doula so lives in our space, doula work, and also has her own podcast. So I will be sharing her podcast information in the show notes so that you can go check it out. It's an amazing resource, all about birth stuff. And tiara, I would love for you to take a second to tell our listeners where you kind of got started on this journey of being in lactation and birth work. And then we'll dive into our conversation for today. Sure, well, thanks again, Kaely for having me today. You know, I love you to pieces. So I'm happy to be here on your platform.
Tiara Caldwell 01:34
To make it like a short story, like I started out
Tiara Caldwell 01:39
as a nurse. So I'm a licensed practical nurse. And I've started my career in the mental health field. And I remember working in the mental health field, you will see all different types of patients, right. So I will see adult patients, Kid patients, but I always kind of felt like tug at my heart when we would have like postpartum patients who were clearly like going through a mental health crisis. So that kind of piqued my interest into knowing I wanted to do something to further help just that population of people.
Tiara Caldwell 02:16
So as we know, mental health, nursing is not for the weak,
Tiara Caldwell 02:22
you have to be very strong to do that work. And I knew that that wasn't where I wanted to stay. So I started to work at a family practice clinic that had our which was partnered with I believe it was Georgetown, their residency program.
Tiara Caldwell 02:39
So there I was, like, I like it here. This is this is better, but it's still not quite where I need to be planted. So I started doing research kind of at the same time of trying to figure out why I had a terrible birth experience with my twins in 2011.
Tiara Caldwell 02:59
And also looking for a certification that I could get as an LPN to make myself more marketable. And then surprise, I found out what ibclc was, by that point, I had exclusively breastfed three children, and it just made sense. And like literally, doors were opened for me to be able to get the training I needed to get my exam paid for, like it was like everything that I needed came to me.
Tiara Caldwell 03:28
So I became a doula in
Tiara Caldwell 03:34
2014 2015. And that same year, I was able to sit for my board, which is crazy, like Mike was hard to get there. So I'm grateful for that. And it's just been a roller coaster since then, but I love what I do.
Kaely Harrod 03:52
That's awesome. I always see that you have LPN. And I like don't register what that is. So you're like, I started as a nurse. And like, of course, that's what that
Kaely Harrod 04:06
That's so silly, because I've known you for a very long time. I'm like, Oh, yes, yes, you're a nurse.
Kaely Harrod 04:14
I do want to just pause and clarify what ibclc is, because like in the lactation world, we have some different kind of random names that we hear. And there is a significant difference. So sometimes I explain it to clients by saying there's like steps, right? Like, like stair steps worth of lactation training. So like me, I'm a lowly to elite leader, you hear that every time I do my intro, but that is like basically, I have my own experience breastfeeding, and therefore I'm like a peer to peer counselor for folks. Right. So I have a little bit of training, but primarily honestly in like communication and stuff, right, and I have my own experience and lactation.
Kaely Harrod 05:00
which is vast many years of experience, but not the medical training that someone who is an ibclc has. When you hear someone say, like lactation counselor or lactation consultant, if they're not international board certified, those are different trainings as well. So what Tiara is talking about is a very rigorous process where you have some medical classes, if you haven't already had some of the sciences that you need, you take those, but in a nursing profession, usually you don't have to retake them. And then you sit for a very extensive exam, that and you have to recertify right, like, there's like lots of stuff that you have to do. Yeah. So it's like the medical, the medical provider, lactation consultant level, and not like a peer counselor, like not just like you have some experience you've breastfed before. Right?
Tiara Caldwell 05:53
Right. I tell people that like and there's of course, there's room for all of those those titles like all of those people are needed. But I kind of compare it like steps like you do. So like I say, think of like nurses like you know, you have your you know, your CNAs LPNs, you have your RNs you have your BSN. So you have your master degree, you know, nurses and then you have nurses who go on to get like their doctorate. So ibclc is like the highest credential for right now. You know, for lactation. Yeah. So it's very,
Tiara Caldwell 06:29
it's a very hard credential to get and to keep. But yeah, just so your audience knows, like the differences between what they might see. Yeah, and I think it's important to also kind of have a sense of when to refer, which is part of what we're talking about today. And this whole Jul series is about.
Kaely Harrod 06:50
But also, I think, in order to refer correctly, you have to understand who you're referring to, or, like for La Leche League we get a ton of folks coming, who really need an ibclc. And they'll say like, Oh, someone told me to reach out to you all, and we honestly just right away pointing to an ibclc. If we're like, yeah, we're like, lower lower tier than you need, you know, like, like, I can help you with some like encouragement and latching missions and like, send you some good articles about milk supply. But for a gameplan about increasing your milk, you really need to see an ibclc you know, so. So I think also having a really clear frame of when and how to refer is an important piece, because oftentimes we delay just unhelpful, so yes, yeah. So, tiara, and I could chat forever, but I'm going to try to rein myself in so that we don't have a 45 minute episode here today.
Kaely Harrod 07:48
I want to start with what is the benefit of a prenatal breastfeeding console, because I see this being the thing that most of my clients are like, Man, I don't need it, even when I've talked about the benefit of it. So what's their try? And like, what would you say? doulas could tell their clients about this prenatal breastfeeding console, kind of how it's been? Yeah.
Tiara Caldwell 08:14
I think that's like my, it's like a niche part of like, my, my work, it's definitely been leaning more towards just prenatals. Because it is so important to see someone prenatally
Tiara Caldwell 08:31
whether it's, you know, your first baby or your fifth baby,
Tiara Caldwell 08:37
because we do so much preparation for birth, you know, and, yes, that's important. But breastfeeding is a whole nother experience, while on top of everything else that's going on in your postpartum period. And you really could benefit from a game plan with that, from
Tiara Caldwell 09:01
knowing what pumps to use if you plan to pump, knowing what to expect if you have a history of a breast surgery. Or if you have history of a low milk supply with
Tiara Caldwell 09:14
a previous child. If your nipples were destroyed with your first child, that doesn't mean that you have to go through that again. And I tell you know, my fellow doulas like it also helps you too. Because as doulas we have to wear so many hats, you know, for our clients. And that will be a great thing that you don't even have to worry about going over with your client like they have a plan that they've gotten from their lactation consultant to follow so you can just help encourage them, you know, on that process, and you can help them with their birth plan, their postpartum planning and things like that. And also, if you have a cool if your client has a cool lactation consultant like me
Tiara Caldwell 10:00
A lot of times I even like let doulas you know, shadow for you know, a prenatal console as well. So you could be able to get some education or ideas to pass on to your other clients. So it's so beneficial and so many people that I work with, in the postpartum period, it's like, Gosh, I wish I would have
Tiara Caldwell 10:20
took at least took a class or you know, had like, a console before like, and it's like, it's fine. You know, we'll just play catch up. But if we can avoid some of that trauma, in the early days of, you know, feeling that will be great. Yeah, totally. I think one thing that I would add to that is that, you know, if you see someone cool, like tiara,
Kaely Harrod 10:43
you also have some relationship already built, right? Yes. In the postpartum time, I really firmly believe that a barrier to care is just figuring out who to see for anything, you know, and it's already overwhelming. And so if you're like, Yeah, I have my ibclc, I already saw her, you know, I already saw them for some prenatally, so I'm just gonna obviously see them again, after the baby comes. I think that also normalizes meeting that that person on your team, like, nobody is thinking like, Okay, I don't need any support in the postpartum time. They're thinking, like, I'm gonna see my pediatrician, right, I'm gonna see the writer that helped me give birth, I'm gonna maybe have some counseling, if I already have a mental health person on my team, and they have these things set up, and ibclc just needs to be one of those things. If you're planning to lactase, if you're planning to feed from your body, then that's an important step to use to just assume you're gonna need some help from a professional when you're doing that. So
Kaely Harrod 11:45
the other thing that I think is important for people to know, and you can tell me to you if I'm accurate in this, but I think when you're going to a provider who does take insurance, oftentimes your insurance will cover a prenatal visit, is that right?
Tiara Caldwell 11:59
Yes. So I would say,
Tiara Caldwell 12:04
maybe, unless you're like a Medicaid, you know,
Tiara Caldwell 12:08
client outside of that, I don't think that there's any chance that that at least a prenatal wouldn't get covered? Because it would be billed under a class. You know, because, you know, it's you getting education.
Kaely Harrod 12:25
Yeah, so, please, like, encourage them who's because, yeah, it's so needed. And then even for like, I mean, I can only speak from my practice, but like, for, you know, my Medicaid clients, like I have sliding scale, like I have, you know, free consults, I have, you know, support groups where you could maybe get, like, some information from there. So, like, there's no reason why you cannot, even if you choose not to feed, you know, yeah, from your breast or chest, after you have the baby, that information that you have on just infant feeding is invaluable for those first, you know, few days. Yeah, well, and I think what we often think about going back kind of, to your point of like, we do all this preparation for birth, but then, you know, we're just like, good luck. Breastfeeding. Breastfeeding is the one thing that starts immediately after birth, I mean, if you're gonna do it, you do it like within an hour of having given birth. And so that's the other thing that I think we sort of compartmentalize it to the postpartum time, but it's one of the fastest postpartum things you have to do that you really need to know, in the prenatal time, like I hear more frequently, people learn how to like change a diaper and baby the baby than they have taken a prenatal class or do a console. And I'm like, but you don't even need to change a diaper baby, the baby for like, at least a day, you know, I mean, that first day, the nurses are gonna help you or if you're at a birth center, that's the folks that are going to help you like, you're not going to be on your own for that. But you're going to have to breastfeed literally in the first hour, you know, and that happens immediately. And so it's really, really important to have a sense of how, how you'll do that and what that will look like so, yeah, okay, so I want to touch briefly I know we're kind of coming up on our time already. But I want to touch briefly on what are some things that you see that doulas don't refer for? And this isn't a shaming episode, right? It's not an episode to be like all these horrible doulas. But I think it's really important to hear from a lactation professional right tiara is the person who who wants you to know this stuff. What they what you see that doulas are like, Oh, that's not an ibclc issue. Because I think it's easy when a baby's like not latching at all or like something really significant, obviously needs intervention. But what are some of the more subtle things that you see doulas just kind of pass over that you wish were referred?
Tiara Caldwell 14:59
A couple of things.
Tiara Caldwell 15:00
Things that immediately stand out to me would be
Tiara Caldwell 15:04
issues with transfer, right? So that could be
Tiara Caldwell 15:09
your clients, baby has not
Tiara Caldwell 15:13
voided or stooled within a certain amount of time.
Tiara Caldwell 15:17
Or it could be
Tiara Caldwell 15:21
your client comes back from a pediatrician appointment, and the doctor says, Okay, this baby has lost this amount of weight. This is true story has lost this amount of weight. We want you to begin supplementation, whether it be with you know, human milk or formula, and then you you tell your client just breastfeed more.
Tiara Caldwell 15:45
You know, or nipple damage, right, you know, yes. Nipple damage, you know, like
Tiara Caldwell 15:54
that, you know, oh, you know, just make sure you put on like, you know, nipple cream or an appointment.
Tiara Caldwell 16:02
refer, refer refer refer even as a ibclc. Guess what guys, I still sometimes refer, if there is just an area where that's not my thing, I'm really not sure.
Tiara Caldwell 16:15
Because the goal is not to be the guru or expert to all things related to your client, right? You're a better provider by referring out getting the best care you can get for your client to help them reach those goals like and it's very easy, especially if you have fed a kid you know, from your chest, or you have a little bit of education
Tiara Caldwell 16:45
to get a little, you know, bit confident and then be terribly out of scope. And then things quickly kind of unravel. So yeah. Feik refer, refer refer and I'm saying that as a fellow doula, you know, because I, when I work, I work very much when I'm going to do literal, I'm going to doula role. And when I need to put on my lactation hat, I put on my lactation hat. So sometimes I have to take off the doula hat and be like, Okay, let me switch to lactation brain here and figure out, you know, what's going on, that could be a lot. So try not to
Tiara Caldwell 17:22
do all the things
Tiara Caldwell 17:25
flange fitting.
Tiara Caldwell 17:27
I mean, you can pretty much tell if you've seen enough flanges, if a flange is too small, but you definitely shouldn't be trying to fit it adjust flanges for clients. But the big one I see a lot is with that supplementation, because we want to protect, of course, our clients goals and plans for feeding. But quite honestly, guys, sometimes we're really messing up that kid, sometimes they need to be supplemented, and the parent at that time does not have enough milk. So you really need to call someone in to see how much they need to be supplemented. What do they need to be supplemented with?
Tiara Caldwell 18:06
And how do we protect that parents milk supply at the same time? You cannot do that? You can't do it as a dude. Yeah, it's too well.
Kaely Harrod 18:15
I think I feel like normalizing things, is a huge piece of the doula work, right, like, normalize that we all have different size nipples, you know, like normalize, someone needs to actually see you pump to know if your flanges fit correctly. Like those kinds of things. I think you can normalize for your client, like maybe your output in nursing, Aaron, pumping is not as good because you have a flange that doesn't fit Have you thought about going to have a flange fitting, not having like TR saying, I think sometimes as a doula you have an intimate relationship with your clients because of what you've been through with them. And so it's easy for them to be like, I'll just call Kaely and ask her what I should do about triple feeding, you know, I'm being told to do this supplementation. And I'm always like, I cannot tell you to not do that. Like the reality is we have to feed your baby. But if your goal is still to either come back to the breast or have mostly your own milk, feeding the baby, we need to get your supply up and we need to make sure that you're still creating that demand. But I can't be the one telling you how and when to do that and also how and when it's safe to stop doing that. I think we do oftentimes see doulas kind of step outside their scope there and be like I think your baby's fine and I'm like, that is dangerous, dangerous territory. Yeah, it is. It's I get scared doing that. You know, I always like even if I know someone's pediatrician is
Tiara Caldwell 19:50
not the best I still say like, Okay, this is what I think but you go back to your pediatrician and see what they say because
Tiara Caldwell 20:00
As you know, they have a higher, you know, licensed than me, they have probably better liability insurance than me. So I go to them and see what they think of my plan or ideas to transition out of this. And at the end of the day, like I tell the parents, ultimately, it's your decision. It's your kid, you know, so I'm going to support you, but I would never be like, oh, yeah, you're making loads of milk. Let's just stop the triple feeding and tell the doctor you're still triple feeding like never. Would I do that? Very dangerous for both the parents and the baby. You'll want to do that. Yeah, yeah. And also, I mean, putting yourself at risk as a doula in terms of overstepping your bounds. You're not a medical professional. So yeah, well, tiara, I clearly need to have you on for like seven more episodes. Yes. A whole tier and Kaylee series? Yes. A whole month.
Kaely Harrod 20:59
Tier and Kaylee chatting through?
Kaely Harrod 21:03
Wouldn't be wonderful. I am gonna put some ways to connect with Tiara in the show notes. Is there anything that you would like to add kind of to finish us off of what you wish jewelers knew?
Tiara Caldwell 21:17
Yeah, so
Tiara Caldwell 21:20
I, you know,
Tiara Caldwell 21:23
give some some feeling education. You know, if that's the thing that you know, you'd like to help with, you would like more information to be able to give your clients
Tiara Caldwell 21:33
you know, get some feeding information.
Tiara Caldwell 21:37
I know my fellow colleagues are nice, she does every now and then like a lactation type of education for birth workers.
Tiara Caldwell 21:48
I'm pretty approachable as well, if you're a doula, so you can find me any way that Kaely puts my info and reach out to me, I'll be happy to give you some information.
Tiara Caldwell 21:59
Get a good idea of who your local lactation consultants are, it's a good idea to know what service areas they work in. It's also really good to get an idea of what their specialties are. Just so if you have a client, you can know who to refer, you know, to? And lastly, I would just say just stay in scope. Yes, like, just please stay in scope. Even if you know the right answer. It's really good to just you know, stay in scope.
Tiara Caldwell 22:36
And just get that, you know, affirmation of being correct. You know, once your client comes back and says, This is what the, you know, providers said, Yeah, but please stay in scope. I want everyone to have long, happy, successful businesses, and it's just not worth it. You know, to be right in a scenario. Yeah, totally. Yeah. Also, she's way understating when she says she's approachable, she's amazing.
Kaely Harrod 23:03
If you're in the DC area, you should absolutely be connecting with her. Yes.
23:09
It's always, you know, a good time. Like I I do my best to make sure that, you know, my fellow birth workers, you know, feel like they can talk to me so that they can ask questions, those, you know, have real conversations about stuff. Yeah, I love that. Well, thank you so much for taking time away from your people. And, you know, coming on here with me to hang out with me and my people. I will be putting all of your information in the show notes, and then I'll schedule our future month of us together.
Kaely Harrod 23:41
Yeah. All right. Until the next episode, really. You're welcome. Bye.
Kaely Harrod 23:53
Thanks for joining us for this episode of the doula Tips and Tips podcast. If you learned something today or had an aha moment, we'd love for you to share that on Instagram and tag us at Herat doula, so we can celebrate alongside you. If you found this podcast helpful. We would so appreciate you taking a second to leave a rating and review on your favorite podcast app that helps other doulas find us as we do this work together. This podcast is intended as educational and entertainment it is not medical advice or business advice. Please consult your own medical or legal team for your own needs around
Lactation is one of the many topics that doulas tend to frequently overstep their scope in. Today’s special guest is talking us through when and how to refer to an International Board Certified Lactation Consultant (IBCLC). If you’re working with families in the early postpartum hours/days/weeks it’s imperative to have some basic knowledge of lactation in terms of what’s normal and what’s not.
Our guest today is Tiara Caldwell. She is a nurse, doula, IBCLC, and podcast host among other things! She is honestly an absolute gem to connect with both professionally and otherwise! Scroll down to read her full bio. She is doing amazing and important work in the DC area. Her links to connect are below as well.
Today’s show covers why a prenatal lactation appointment is important as well as how detrimental it can be to not refer when it’s really needed! It’s vital to a good doula practice to be willing and ready to refer. Tiara highlights how you really need to know what lactation resources are available in your area so you can send clients to the right places who will actually be helpful to them.
Quote from the show:
“To doulas I’d say…refer, refer, refer!.... Because the goal is not to be the guru or expert to all things related to your client, right? You're a better provider by referring out getting the best care you can get for your client to help them reach those goals like and it's very easy, especially if you have fed a kid you know, from your chest, or you have a little bit of education to get a little, you know, bit confident and then be terribly out of scope. And then things quickly kind of unravel.”
OUR GUEST:
Tiara Caldwell, LPN IBCLC, has been a maternal and infant health advancement champion for over ten years, starting with her work as a community doula and mental health professional. She became certified as an International Board Certified Lactation Consultant in 2015 and, shortly after, began work as a private practice practitioner and working part-time in the hospital setting.
She owns Crowned & Cradled LLC, a company in the DC Metro area that provides doula support and lactation services. Tiara is known as a compassionate caregiver and savvy businesswoman in her community and field. Her areas of expertise range from prenatal education, support for families of multiples, and ways for business owners to find their unique voices and craft marketing efforts to mirror them. Tiara has presented at various conferences and received raving reviews and additional business growth opportunities.
The heart of Tiara's work is providing families with the keys they need to have successful feeding experiences in a judgment-free space. Being a mother of four children and navigating multiple unique family structures herself, Tiara can offer a culturally appropriate, sensitive, and respectful approach to care to encourage families to reach their goals. She does this by continuing to collaborate and contribute to community organizations with support groups and classes and co-hosting a podcast called Birth. Ish.
Resources: Lactation Education Resources https://www.lactationtraining.com/resources/handouts-professionals
CONNECT with Tiara:
Website: http://crownedandcradled.com/
Facebook: https://www.facebook.com/Crownedandcradled/
Podcast: https://podcasts.apple.com/us/podcast/birth-ish-the-podcast/id1509477662
CONNECT with Kaely on TikTok or Instagram
https://www.tiktok.com/@doulacoach
https://www.instagram.com/Harroddoula/
If you like this episode, don't forget to share it to your Instagram stories and tag me @harroddoula
Kaely Daily is produced by Kaely Harrod of Harrod Doula Services
It is sponsored by The Birth Prep Blueprint Childbirth Class
Music by Madirfan: Hidden Place on Pixabay
