Physician, Know Thy Breasts

Here’s a sentence I saw today and which—with small variations—I have seen or heard many times throughout my career:

“The mother saw a breast surgeon, who did not have a vast knowledge of the lactating breast, but…”

OK, the writer is entitled to call a spade a spade and state the surgeon’s shortfall of knowledge. I’m okay with that. In fact, I hear if often enough that I don’t doubt it’s true. What I can’t understand is, why, exactly, a doctor whose work is to operate on the breast “[does] not have a vast knowledge of the lactating breast”?

After all, the biological function of the human breast is to lactate. That is its very purpose. So how can a “breast surgeon” not be knowledgeable about the organ when it is functioning as it is intended?

Consider: When would we ever hear someone say, “The man saw a lung surgeon who did not have a vast knowledge of the breathing lung…” or “The woman saw a foot surgeon who did not have a vast knowledge of the walking foot…” Puh-leeeze! How is it possible that a doctor could be authorized to diagnose, treat, and incise an organ for which he or she “did not have a vast knowledge of” it working as intended, performing the function it’s supposed to do?Help! I don’t get it!

It is simply not acceptable that breast “specialists” do not have a complete understanding of the lactating breast. True, many of the breasts the specialist sees in a day may not be lactating at the time. But neither are many of the feet that specialist sees in a day dancing. Or running.

Considering one’s self to be a “specialist” and having knowledge only for those times an organ is not functioning seems rather silly, don’t you think?

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“Breastfeed Early and Often” Key for Mothers, Newborns in Hospital (and After)

The American Academy of Pediatrics (AAP) recently updated its policy statement on “Hospital Stay for Healthy Term Newborn Infants.” There are a number of important directives in this statement, but a few points are especially key for nurses and others working in the hospital setting with breastfeeding mothers and their infants.

Once again, the AAP points out that jaundice, dehydration, and feeding difficulties are the most common reasons for readmission of term and near-term infants to the hospital. This is by no means news; these three factors have been identified by past studies, such as one by Brown, et al. published in 2000. (It’s been more than 15 years since that was written, yet these factors continue to be problematic. See also Danielsen 2000 and Escobar 2005.)

I postulate that these three reasons—jaundice dehydration, and feeding difficulties—are not in fact, “three” problems. There’s one main problem here: lack of sufficient breastfeeding. If infants were breastfed early and often, there would be a much lower incidence of newborn jaundice. DeCarvalho and colleagues published their landmark study in 1982 showing a clear inverse relationship between number of feedings and incidence of newborn jaundice, yet parents still recount a plethora of reasons why their baby could not get to breast early and often. Worse still, once jaundice develops, further difficulties arise. The infant who is jaundiced is frequently lethargic, and therefore not eager to breastfeed. (Anyone who has worked on a maternal-newborn unit is not surprised to hear me saying this.) It’s so common, and yet it seems to me that very little has been done to get the early-and-often feedings that would help head off jaundice.

Certainly, there is a clear correlation between jaundice and dehydration. So again, my constant mantra of breastfeeding early-and-often would go a long way towards hydrating the baby, since human milk is about 87% water. How hard is it to understand that until the newborn gets to breast early and often, dehydration will continue to be a problem and a reason for hospital readmission?

Finally, the AAP points out that the newborn should complete two “successful” feedings before hospital discharge. If indeed a caregiver who was “knowledgeable in breastfeeding, latch, swallowing, and satiety” could observe the baby, that would be a step in the right direction for preventing the jaundice and the dehydration. Whether such a “knowledgeable” person is present and available on the maternal-newborn unit is often debatable.

As a nurse on the front lines of postpartum care in 1995,  I was relieved when the American Academy of Pediatrics included “two successful feedings, with documentation that the baby is able to coordinate sucking, swallowing, and breathing while feeding” in what was then its list of criteria to be met before hospital discharge of a healthy term baby. I felt sure that the call for care providers to observe, determine, and record information about such feedings would be the linchpin for keeping babies in the hospital until a successful feeding had occurred. Today, I realize that creating a policy statement—while necessary—is not sufficient for changing the situation. The problem with readmissions is not the readmission. It’s the lack of successful feeding before the initial hospital discharge.

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Clinical Hours for IBLCE Exam Eligibility

Over the years, the Breastfeeding Outlook staff members have fielded many calls about the clinical hours requirement for taking the IBLCE exam. Our first step is always to recommend the IBLCE candidate check the IBLCE site but if they are still confused, we do try to help. I thought I’d “heard it all” but last week a potential IBCLC called with a new problem. She had misinformation about how to calculate the required clinical hours and whether a shortage of clinical hours would bar her from getting her 90 lactation-focused education hours.

Her role, her involvement
The caller was a certified nurse midwife (CNM) who has been in practice for more than 25 years. She works part-time in a clinic, doing what you’d expect any CNM would do: diagnosing (including lactation-related conditions), prescribing medications (including medications for such ailments as mastitis), counseling mothers about breastfeeding, determining whether the breastfed baby is making adequate weight gains and meeting developmental milestones, and more.

The caller thought she would be ineligible for the IBLCE exam in July, because someone had told her she did not have enough clinical hours. I listened carefully to her story, and I couldn’t reach the same conclusion.

Calculating her hours
I’m not a CNM myself, but I imagine that a CNM in the clinic setting would spend at least 50% of her time with breastfeeding mothers. (In the state where she works, breastfeeding rates are high.) Using rough numbers, I calculated that if she worked 25 hours a week for 50 weeks a year, she would have accumulated over 1200 work hours in one year. Even if she spent only half of her day helping breastfeeding mothers or couplets, she would have accumulated about 600 hours during one year, and 1200 hours in two years. That would easily exceed the IBLCE’s requirement, stated as a “minimum of 1000 hours of lactation specific clinical practice that was obtained within the 5 years immediately prior to applying for the IBLCE examination.”

I was stumped, so I asked: “What makes you think you don’t have enough hours?”

Some pesky 10% number
Someone in her city had told her that only 10% of the hours worked in a clinic counted as “breastfeeding” hours. I had never heard that. I’d never read it before. A thorough search of the IBLCE’s web site did not produce such a rule. (If you’ve heard it before, please comment below with where you heard it!)

Somewhere in this discussion, the caller said she had been denied admission to an education course because of her lack of clinical hours. That led me to believe that she might have confused an academic institution’s admission requirements with exam requirements. Those are two different things.

Over the years, we have admitted many, many IBLCE exam candidates to our Comprehensive Lactation Course. Perhaps some other educators have clinical hour requirements, but we do not. In fact, some candidates have come to the course even though they have accumulated no clinical hours whatsoever.

Lessons to be learned
There are a few lessons to be learned here:

– First, requirements for admission to a course and requirements to sit for the IBLCE exam may be very different. (And requirements vary between Pathways 1, 2, and 3 as well; we know it can be confusing!)

– Second, it’s best to go the primary source for information; a friend, colleague, or other person might unknowingly mislead you.

– Finally, don’t hesitate to  call us if you have questions–even if you think you’ve been stopped in your tracks. We’re here to help you land your dream job.

Leave us a comment (or give us a call) if you’ve been confused about IBLCE exam requirements.

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Preparing for the IBLCE Exam: The Transformation Process

For the past week, I’ve been teaching my Comprehensive Lactation Course and Picture Perfect seminar in sunny Orlando, Florida. It was an exhilarating week! Course attendees were exceptionally smart, hard-working, and appreciative. I was inspired by them. The teaching room was full of energy and—more importantly—synergy—for the entire week. This morning, I reflected on the course success.

Every single person in the group signed up for the course wanting more than just the 90 credits that are required to sit for the IBLCE exam. Each person was there to learn as much as she could from the course; to learn from other attendees after the course was dismissed each day; to become a better version of herself. One woman–39 weeks pregnant–shared that she attended the course to become a better nurse and a better mother. Several attendees said they could have attended a different course closer to home, but made the trek to Orlando because they felt my course would provide a better, more interactive learning experience. Two came from outside of the US. A few told me they had bought an online course from another vendor, but didn’t find that to be a satisfying learning experience. They too signed up to become a better version of themselves.

Me, with a couple of the wonderful ladies from our week in Orlando!

Me, with a couple of the wonderful ladies from our week in Orlando!

Over the years I have been teaching, I’ve noticed there are generally two kinds of people who enroll in an IBLCE exam prep course: (1) Those who attend out of a need to check the box—travel the shortest distance, pay the lowest fee for courses or materials, listen to the required content, and put forth the least possible effort. (2) Those who seem have a deep desire to become a better version of themselves through engaging in the learning process. They go the extra mile, learn the extra material, and enthusiastically engage in their own learning. This past week, there were 30 of the second type of people with in my Orlando. I felt as if I was watching their transformation during a 5-day period. It was fantastic to be a part of their process.

That energy and synergy has a relatively simple explanation. I do believe that as humans, our deepest desire is to become a better version of ourselves. All people seem to be aware of that desire. A few pursue it some, most, or all of the time. Most people ignore that voice calling them to be the best version of themselves. Which are you?

If you’re one who wants to do more than “check the box” towards the IBLCE exam, I invite you to join me for a free webinar on “Becoming a Lactation Consultant.” Register today for the next session, then join us online or on the telephone. It’s a short (1-hour), easy, convenient start to becoming a better version of yourself.

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There’s No Place Like a Baby-Friendly Hospital

A few days ago, I talked with a prospective client about her hospital’s efforts to earn the Baby-Friendly designation. Like many other hospital personnel I have spoken with, she noted that her hospital was “stuck” trying to meet the requirements of the Baby-Friendly Hospital Initiative (BFHI). I hear this often, and it’s become something of a song to me. I find no matter who is “singing,” it tends to have pretty much the same tune and the same three stanzas.

Over decades of working with organizations on system-level change, I have found three common sticking points for hospitals and other groups:

  • Institutional factors—The policies, procedures, protocols, structures, norms, values, staff buy-in, etc. aren’t present.
  • Implementation factors—The “structure” is present, but the process is considered cumbersome. “We can’t do X because of Y.” (Sometimes, tough analysis shows this is really “We think we can’t do X because of Y,” or even “We think we are doing X—but we aren’t.”)
  • Familial factors—The hospital personnel committed to evidence-based practice would do “it” (whatever “it” is) right, but mothers/families want no part of it. “Rooming-in? Noooo, thanks. This is my last night to sleep before I go home!” That kind of thing.

The refrain is always the same: “We’re stuck, we’re stuck, we’re stuck.”

As the consultant, it’s my job to sing a new refrain, of success! I’ve never met a “stuck” hospital that couldn’t—with a bit of critical analysis and careful guidance—be unstuck.

With a little humor, I could probably put my consultancy to music from The Wizard of Oz: “Because, because, because, because, because…” That would be perfect. After all, part of my role is to help health care providers see they have what they need—brain, heart, and courage—as they establish a baby-friendly “home” (away from home) for the mothers and babies in their care.

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When I Got My IBLCE Exam Results I Felt …

like I had just won a pole-vault event!

Here’s what happened. I was on the road, headed to teach my Comprehensive Lactation Course in Dallas, TX when I got a text message from Linda in my office. (If you have ever had the pleasure to talk with Linda, you know how wonderful she is!)

Her text read: “Looks like your IBLCE results came in the mail. Do you want me to open the envelope?”

I instantly sent a reply text shouting, “YES!” I eagerly awaited a reply, but none came. At first, I thought “Oh, well, it’s Monday morning, the office is probably busy.”

After a few more minutes, I thought “Oh, what if I didn’t pass? Linda might be sitting there trying to figure out how to tell her boss she failed!”

Finally I got the text. Two words that carried huge weight: “You passed.”

Whew! Honestly, maybe it’s just that I’m getting older, but I admit I was nervous on the way to the exam site this summer! I’m very confident of my computer skills, but there was something creepy about doing the exam online. And, I’m still miffed about how they allot the timing of each section, as well as how they describe how much time you have to complete each section. This was nerve-wracking from start to finish.

Why did I feel like I had won a pole-vault event?

Because this year’s scoring is the highest IBLCE has set the “bar”—ever. The pass rate for this year’s exam was 71.4% (125 of 175 questions). Never in the history of the IBLCE exam has the passing rate been this high.

The only thing that matters, though, is whether you jumped over that bar. No one knows—or cares—if you cleared the bar by a tenth of a point or 10 points or more. As long as you cleared it, you get to use IBCLC after your name. There! Now you know how I felt when I got my results!

How did you feel when you got your exam results?

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Help for Mothers with Postpartum Depression

According to the American Psychological Association, about 9-16% of American mothers experience postpartum depression. That’s about 1 in every 7 to 10 mothers. The prevalence of postpartum depression among mothers who have experienced it previously is even higher–estimated to be about 41%. Do these figures sound staggering? They are. Sadly, they may not reflect the whole problem. Many women are reluctant to talk about their symptoms and go undiagnosed. An accurate count of postpartum depression incidence may actually be much higher.
 
Sources such as WebMD report what many of us hear from new mothers we know. They realize they feel depressed and that something is wrong. But when they report it to their doctors at their 6 weeks check-up, they are told that it is the “baby blues” due to “hormones.” They are assured it will go away. For many women, it doesn’t. Treatment is just delayed while they struggle with depression unaided.
Similarly, women are often given erroneous advice about breastfeeding—including the advice to stop breastfeeding if they feel depressed—and yet, there is no evidence that breastfeeding causes or contributes to postpartum depression. (To the contrary, at least one study has suggested that breastfeeding may help protect against postpartum depression.)
 
Understandably, when facing these obstacles, many women lack the strength to talk about their depression, or get the help they need.
Luckily, some women do talk openly about their experience. Singer and talk-show host Marie Osmond went public about her struggle with postpartum depression on Oprah and Larry King Live, helping thousands of women to realize they are not alone.  Her book, Behind the Smile, demonstrates to all mothers that it’s possible to get help, get better, and move on.  Similarly, actress Brooke Shields shared her experience with postpartum depression (including suicidal thoughts) in the media and through her book Down Came the Rain, shedding light on the problem. In a book out this month, Amy Poehler talks candidly about her experience with postpartum depression after the birth of her first child and how one doctor recommended she put on a “pretty dress” and see a Broadway show to resolve it. (As if!)
Whether you are a mother with sad feelings, a loved one of a mother who has experienced postpartum depression, or a professional who wants to help mothers talk about their situation and empower them to continue breastfeeding, you’ll want to hear my discussion with author and expert Dr. Kathleen Kendall-Tackett about the myths and facts about postpartum depression, from recognizing the problem to seeking help and overcoming it.
“Depression is a prison where you are both the suffering prisoner and the cruel jailer.” — Dorothy Rowe
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Formula and GMO. OMG!

Have you ever chuckled at the sight of a parent buying organic formula for her infant? Does it seem a bit like putting a bouquet of fake flowers into a crystal vase full of water?

Okay, maybe you’re thinking something a little different than that, but you have to admit that the idea is worth a laugh. It may seem that the parent is in denial, assuming that organic formula is somehow a better match for human milk than standard formula. Or maybe it seems that the organic label has prettied up the repulsive formula, so that the parent doesn’t have to feel guilty about not breastfeeding.

You and I probably agree that nothing is equivalent to breastfeeding. But if you’re laughing about the parent’s selection of organic formula, I encourage you to read Dr. Michelle Perro’s guest post on GMOInside. Dr. Perro, a pediatrician, gives a strong recommendation for breastfeeding, but notes that she “insists upon” organic formula for babies who are not being breastfed.  Why?

As Dr. Perro explains, non-organic formula contains herbicides, products that are toxic to plants. One frequently-used herbicide, glyphosate (GLI-fo-sate), has toxic effects and is detrimental to infant development in two ways:

  1. Exposure to glyphosate impairs the baby’s immature liver function, changing important enzymes and immune function. Hence the amount of “friendly” bacteria in the baby’s gut decreases, which leaves the baby’s gut to be occupied with “enemy” bacteria.
  2. The baby’s liver does not mature until about 2 years old. Although she does not for a moment imply cause and effect, she does note that the pesticides in formula may be in some way related to an alarming increase in childhood disorders, including allergies, autoimmunity, and neurological disorders, including autism and ADHD.

Should we wait for logic and studies to “prove” such a relationship, or should we just look right now at the labels of our formula bottles and, feeling disgusted at the known contaminants, choose the best we can?

In my Comprehensive Lactation Course, I show real labels from real formula cans. In her article, Dr. Perro does the same. You can look at some for yourself.

The first two ingredients you’ll probably see in this staple of “baby nutrition” are corn syrup and sugar. Are you horrified? Did you think that in today’s world we would have moved beyond corn syrup and sugar as a source of “nutrition” for our babies? Are you outraged? Do you feel like the baby is being fed pecan pie filling without the pecans? But that’s just the tip of the iceberg.

Corn syrup and sugar are worse than you think. These have a high degree of genetic modification. Allow me to explain what that means. The NonGMO Project defines genetically-modified organisms (GMOs) as “plants or animals that have been genetically engineered with DNA from bacteria, viruses or other plants and animals.” Eewwwww! Are you as repulsed as I am by the idea of genetically-engineered DNA from bacteria, viruses, or other plants and animals going into a newborn’s body? Of course you are. Anyone would be—anyone, apparently, except the majority of Americans.

As the NonGMO Project explains, “[m]ost developed nations do not consider GMOs to be safe. In more than 60 countries around the world, including Australia, Japan, and all of the countries in the European Union, there are significant restrictions or outright bans on the production and sale of GMOs.”

Let’s think about this. We are allowing the youngest members of our society to be exposed to this wretched stuff from the day they are born. At the same time, we worry that we should not make mothers “feel guilty” for feeding their babies with formula.

Maybe we should feel guilty for ever letting this pesticide-laden stuff go into what is, for all too many babies, their sole source of nutrition. And I, for one, should stop laughing at the idea of organic formula.

 

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A Born to be Breastfed (and Marie Biancuzzo) Milestone

I am pleased to share the text of the press release that posted today celebrating my one-year anniversary helping moms and health care providers in my role as “Born to be Breastfed” host. Please share. –MB

Born to be Breastfed Celebrates One-Year Anniversary Helping Moms and Health Care Providers

–Marie Biancuzzo enters second year on VoiceAmerica’s Health & Wellness Channel. –

Herndon, VA, September 29, 2014 Marie Biancuzzo, host of “Born to be Breastfed,” celebrated her show’s one-year anniversary on the VoiceAmerica Talk Radio Network with the announcement that it will continue through fall 2015. The show airs every Monday from 6 PM to 7 PM ET on the VoiceAmerica Health & Wellness Channel, and it is available as a free podcast on iTunes and Stitcher.

“On Born to be Breastfed, I aim to help mothers bust through the myths and clarify the facts about breastfeeding,” explained Marie Biancuzzo, Past President of the Baby-Friendly USA Board of Directors and current Educational Director at Breastfeeding Outlook, a continuing education provider accredited by both the American Nurses Credentialing Center’s Commission on Accreditation and the International Board of Lactation Consultant Examiners. “We’ve done this since the first episode—but there is still a lot of material to cover.”

“We’ve had a diverse and excellent group of guests on the show, including Diana West, Karen Kerkhoff Gromada, James Akre, Nancy Mohrbacher, Kimberly Seals Allers, the Laurie Berkner Band, and many others,” Ms. Biancuzzo said. “Every week, our guests help us explore issues of maternal and infant health, child feeding and development, public health, and social and cultural issues to support listeners in setting and meeting their breastfeeding goals.”

“The show has been a welcome addition to the VoiceAmerica line up,” noted Born to be Breastfed’s Marketing Director Celina Schneider. “Listens to show podcasts average about 16,000 each month, the show has been in the channel’s Top Six for the past seven months, twice at #1. We’re looking forward to seeing what’s coming in the year ahead!”

To celebrate this one-year anniversary, “Born to be Breastfed” is offering listeners the show player to put on their website for free! Contact Celina Schneider at celina@breastfeedingoutlook.com for details.

Tune in to “Born to be Breastfed” each Monday at 6 PM ET (3 PM PT) on the VoiceAmerica Health & Wellness channel, or listen to past shows as podcasts through iTunes, Stitcher, or the show’s web site.

Contact: Celina Schneider, Marketing and Advertising Director
703-304-8079
celina@breastfeedingoutlook.com

 

About Marie Biancuzzo/Born to be Breastfed
Marie Biancuzzo, RN, MS, IBCLC, host of “Born to be Breastfed” is an experienced breastfeeding professional who aims to cut through the misinformation, bust the myths, and help families figure out what science they can trust. A clinical nurse specialist and international board certified lactation consultant, Marie has more than 3 decades of experience in community and teaching hospitals, counseling mothers, and teaching health care providers. From the mother’s bedside to the university classroom to the international continuing education arena, Marie has honed her skills at helping listeners to clarify the facts empower the family. Author of two books and multiple articles, Marie is passionate about helping parents and providers to be good consumers of health care and scientific information. Marie is a founding member of the United States Breastfeeding Committee and the past president of Baby-Friendly USA Board of Directors.As the Educational Director of Breastfeeding Outlook, Marie helps nurses and other breastfeeding educators learn what they need to know; through Born to be Breastfed, Marie—and her expert guests—help families, too.

About VoiceAmerica/World Talk Radio LLC
World Talk Radio, LLC is the world leader in online media broadcasting and the largest producer and distributor of live internet based talk radio and TV, delivering over 1,000 hours of programming weekly on its VoiceAmerica™ Network (http://www.voiceamerica.com) as well as live and on-demand video content on VoiceAmerica.TV (http://www.voiceamerica.tv). Featuring more than 200 hosts broadcasting to seven niche community based channels: its flagship VoiceAmerica™ Variety Channel, VoiceAmerica™ , Empowerment, VoiceAmerica™ Health & Wellness Channel, VoiceAmerica™ Business Channel, VoiceAmerica Sports, 7th Wave Channel, and VoiceAmerica™ Kids Channel. VoiceAmerica™ TV offers targeted and exclusive video programming channels. VoiceAmerica™ /World Talk Radio, LLC is one of the pioneers in internet broadcasting, producing and syndicating online audio and video, offering an innovative, effective and comprehensive digital broadcast platform. Digital Publishing through its 14 years of broadcast and media experience along with our seasoned staff of Executive Producers, Production and Host Services Group, VoiceAmerica™ /World Talk Radio, LLC provides an internet radio and video platform for new, emerging and veteran media personalities to expand and monetize their business and brand in an online digital medium.

 

To learn more about the new radio program, visit the VoiceAmerica Health and Wellness Channel website: http://www.voiceamerica.com/Channel/248/voiceamerica-health-and-wellness

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Choosing Success

Making choices is seldom easy. I hear this all the time. Women tell me about the choices they’ve made—or choices they’ve allowed to be made for them. They tell me how they felt hesitant to make any choice, or compelled to make the “easier” or more “reasonable” choice than the one they really wanted, the one that would lead them to a sense of fulfillment. Whether it is how to feed their babies or what to do with their career, many have one thing in common: They settle for the reasonable choice rather than the right one, the one that would lead to a life-changing experience.

I hear it a lot: “I want to get my IBCLC credential …” “I want to get my lactation credits …” “I want to get a job where I can help moms with breastfeeding …” “I want to own my own business …”

Too often, this is followed by “…but I can’t because …”

Although these women want to help mothers overcome challenges and achieve breastfeeding success, they allow themselves to be caught up in professional challenges that stymie their own success. They acknowledge that they are making a choice that feels difficult or even unreasonable under the circumstances. But their decision-making process lacks something that the women who go after what they want have.

I remember a woman who came up to me at the end of my Comprehensive Lactation Course in Dallas. She told me about her low-paying job, parenting responsibilities, unsupportive boss, distance from the course—a host of barriers that could have been a deterrent to pursuing the credential she really wanted. She said it had taken her seven years to organize the time and money it took to attend the course, and that she had done so only after a lot of “shopping” for the course she thought would best help her pass the exam, get a better-paying job, and help other mothers to breastfeed.

The course had just finished, I was done teaching for the week, and here I was learning something from the woman I’d just been teaching! As I hoped that the course would help her reach her goals, I felt impressed that although it took her so long she had stayed the course. Women who are empowered to make the choices they most desire—not necessarily the easy or reasonable ones but the ones that are right for them—have a connection with themselves and with other people.

The conversation called to mind this quote, from Robert Fritz’s The Path of Least Resistance: “If you limit your choice only to what seems possible or reasonable, you disconnect yourself from what you truly want, and all that is left is a compromise.”

The journey to IBCLC is often challenging, but commitment to what feels right for you can make all the difference.

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