About the Author

Lactation consultancy didn’t exist when I left school, so it was never a long term goal.  I have been a lactation consultant (LC) since 1986 (first exam 1985), and was the first one to be qualified internationally (IBCLC) in Western Australia.  As an active member of the Australian Lactation Consultants Association (ALCA) I was a member of the organising committee for the 2002 Biennial conference in Perth.  I have been working as a community child health nurse in several locations (metropolitan and rural) since 1984, and to date the IBCLC has not been a pre-requesite for my employment.  The role of the LC is intimately tied to the normal function of the infant and the normal physiology of the mother.  In the past 10 years it has come to my notice, that ‘we’ (health professionals) do not actually include feeding assessment as part of our universal of infants following discharge from maternity care.  I have become interested in practice based evidence as the foundation for problem solving in lactation and feeding difficulties.  Between 1962 and 2006 I was mainly concerned to be evidence based in my practice, gradually it became evident that clinical practice grows our knowledge base for what actually happens for mothers and babies, whereas good evidence based practice may be impossible if the evidence we use is not based on the clients we see everyday.

I am sure my family and friends are fed up with my interest in the feeding behaviour of infants, but having ‘seen’ the ‘gap in assessment’ it is hard to ignore it with a clear conscious. I developed a screening tool which included the factors which seem to impact most on feeding, and are either seen by the mother or felt by her as pain.  This was to be the subject of a professional doctorate, but has proved to be problematic, academically.  It is more important that parents are able to change behaviours ‘now’ and not wait for the theory based practise which is usually mooted as vital.  Health behaviours should be easy behaviours and the same applies to correction of feeding problems in health mothers and infants.  I wrote the book, so that at least it was ‘written down’, so at least it ‘exists’.  The suck assessment and re-training method on Page 58 is the basis of what you need to know and feel about baby’s suck.  If this assessment was done correctly, with milk in the tube, we professionals would know much more about the signs of dysfunction that we see.  It is a slow process, changing a paradigm.  We spent 120 years being concerned about infant survival and prevention of malnutrition – the last 60 years indicate that this is no longer ‘the problem’ as child hood obesity raises it global profile.  Just as athletes hone their physical skills, we need to assess and re-train infants to be efficient feeders, regardless of the type of milk they are consuming.

The last 3 years have been taken up with part time academic studies, as I try to increase the credibility of this idea.  In reality it is mostly about the mechanics of suck and posture.  Motor mechanics seem to understand the concept within 3 minutes, parents can be trained in another 3.  It is not rocket science, as they say, but it is based on the basic principles of physics and the movement of fluids from one place to another.  Mothers should not have sore nipples – just as tyres should not be worn on one side.  Babies should be able to feed efficiently in 10-20 minutes – it is not a marathon and should not seem like one to the mother.  Tongue tie of any degree should not be ignored, if there are associated symptoms in the mother or baby.  Suck assessments are easy to do and easy to fix in healthy full term infants.  I know that established protocols are hard to alter, but it the steady drip, drip, drip of water which eventually alters the shape of the stone.