Stories and guest posts

A tapestry of support: Dr. Pam Heggie on serving families as an MD IBCLC

Dr. Pamela Heggie is a pediatrician and IBCLC in the Twin Cities who has established herself as a strong advocate for mothers, babies, families, and lactation support. She was kind enough to answer some questions I had for her about her practice, how breastfeeding became a professional interest, the value of having lactation support within a clinic setting, and how she feels about the licensure bill that is approaching the Minnesota legislature. She also provides tips about finding a pro-breastfeeding doctor for your family in this blog post.

Dr. Heggie is a Clinical Assistant Professor of Pediatrics at the University of Minnesota, and moved her general pediatric care and lactation consulting practice to Central Pediatrics (in St. Paul and Woodbury) recently.

What education about lactation did you have before becoming an IBCLC? 

I did my training in pediatrics at the University of Rochester in Rochester, New York, the home of the “grandmother of breastfeeding medicine,” Dr. Ruth Lawrence, author of the book Breastfeeding: a Guide for the Medical Professional. Her presence at the medical center helped to establish a breastfeeding-friendly training program and Dr. Lawrence was a mentor for me. She always emphasized the importance of considering breastfeeding in every hospitalized baby we talked about on rounds.

I suppose I should also say that my lactation education started when I was born. My mother breastfed me in the 1960s, when the trend nationally was to formula feed. Throughout my childhood, she often told me stories about her breastfeeding experience and how she needed help. Remembering her commitment to breastfeed me and to get lactation support was helpful for me after the birth of my first baby, another learning experience… seeking help from a lactation consultant. As a doctor I thought I “knew” how to breastfeed, but I soon realized I needed some guidance and encouragement. I gratefully discovered La Leche League and I saw a lactation consultant a few times… all part of my early training in breastfeeding! So I had extensive lactation “training” before I actually started taking courses.

Then I attended a seminar about breastfeeding at an American Academy of Pediatrics national meeting, and went to some local lactation educational events where I was the only doctor in the audience!

What led you to become an IBCLC?

As I mentioned, I had been aware of the importance of breastfeeding since my early childhood and during pediatric residency. I considered myself to be a breastfeeding advocate, and I referred mothers with breastfeeding problems to the lactation consultants in the hospital I worked in. We were doing great collaborative work until 2005, when the hospital administration decided to terminate the lactation consultant service, and all of a sudden I had no one to refer to when I had a newborn patient and mother who needed breastfeeding help. So I jumped in and learned as much as I could about lactation consultation so I could help my patients. Then I found myself “fully trained” with all the course work I needed to sit for the IBCLC exam in 2008. At that time I also heard about the Academy of Breastfeeding Medicine and learned that doctors can do this kind of work, not just refer moms and babies who need help.

So I decided to become a lactation consultant and start practicing “Breastfeeding Medicine” with my dual MD-IBCLC certification. Since then I have also become a fellow of the Academy of Breastfeeding Medicine (FABM).

What influence does your medical background have on your practice as an IBCLC? Do you work mostly with families who are having breastfeeding difficulties? Do you wear different “doctor” and “IBCLC” hats when seeing patients, and, if so, how do those hats differ?

I think I wear both “hats” all the time; depending on the type of visit or family concern, I put one hat on more snugly, and I always try to see my patients through both lenses. If a baby has a primary physician and I am seeing the baby and mom for a breastfeeding medicine consult, then I will concentrate on the feeding issues mainly and refer some of the medical pediatric issues back to the primary doctor, such as a skin rash that is not related to the breastfeeding problem. However, if the baby is not gaining weight well, I may do some medical lab tests on both baby and mother to look for any underlying medical issues I don’t want to miss and that could be potentially treatable. My medical perspective is always in the room with me even during a lactation consultation.

When I see a baby for pediatric well-child care, questions and dialogue about breastfeeding often come up and I am able to talk about how breastfeeding changes as babies grow and develop. I can talk about how a distracted 4 month old may only nurse for a few minutes and may need a quiet calm place to nurse at times and how much this differs from what mom may have experienced with a newborn or 2 month old. In pediatrics, I see the continuum of breastfeeding throughout the first years, and I can be a resource about introducing solids, weaning or breastfeeding a toddler depending on what the family brings to each well-child appointment.

What is the value—in terms of income, patient satisfaction, or anything else—of having an IBCLC on staff in a pediatric or family practice clinic? What types of practices might benefit from having lactation support on staff?

More and more pediatric (and some family practice) offices have started to realize the benefit of having a lactation consultant on staff. Families are looking for this type of practice and are more satisfied when they feel that their breastfeeding goals are being supported. The babies are often seen two to three times in the first few weeks at the primary care office and these visits are usually about feeding and weight gain—a perfect opportunity for guidance and support about breastfeeding. Milk supply is established in the first few weeks, so if a mom can have the support she needs (from a lactation consultant) to be comfortable, understand her body and how she makes milk, at the same time the baby is being examined and monitored by the doctor then it leads to patient (and physician) satisfaction.

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The practice can provide a collaborative approach to allow efficiency for everyone involved. The lactation consultant can often spend more time with mom and baby than the doctor can, helping to address breastfeeding concerns early on, before mom may want to give up and milk supply is low. And there is a great advantage to have both lactation consultant and doctor in the same location so they can share in the care planning together. This communication benefits all in the long run and this collaborative work can be financially viable for the practice if carefully designed.

Do you feel that someone who provides outpatient lactation support in a clinic setting should be an IBCLC, or are other credentials such as CLC sufficient? What education or experience would you want to see in someone who provides support in this setting?

I think all levels of experience have a role in the outpatient clinic. There will be scope of practice differences and that is okay as long as the practice recognizes the difference.

What’s your opinion on the benefit of licensing for IBCLCs, and how might licensure change the landscape of lactation support in Minnesota and elsewhere?

I fully support the bill being introduced in the Minnesota legislature this session to license lactation consultants. I think having training standards outlined in order for someone to be licensed as a lactation consultant is a good thing, to minimize the confusion about who is giving lactation support in the community and what their scope of practice is. The licensure will also allow better reimbursement for lactation consultation by both medical assistance and private insurance. Currently the lack of adequate reimbursement for IBCLC lactation services is a big problem in our state and country. Many hospitals and clinics are hesitant to hire lactation consultants (or actually are quick to cut staff) because of the cost of lactation care that is not reimbursed. This has led to a shortage of IBCLCs, particularly in rural areas of the state. Moms are not getting the support they need to reach their breastfeeding goals.

With licensure comes better reimbursement, and, therefore, more access for moms throughout the state to get IBCLC level care. This is not to exclude the excellent counseling that non IBCLCs provide, such as CLCs and in La Leche League and other programs providing information and support about lactation. These counselors are vital to the web of breastfeeding support we need in the community! Not every mom needs IBCLC-level care, just as not everyone with a sprained ankle needs orthopedic care.

I see lactation support and guidance as a tapestry. All moms, babies, and families are woven into the fabric of breastfeeding advocacy, and all who want to help with breastfeeding in whatever way is needed are welcome to be part of this woven fabric. By working together and being there at the right time and place to support breastfeeding m oms and babies is what our state needs most. The licensure bill is just one small step in making sure ALL moms get the support they need to breastfeed their baby if they want to and to reach their goals.