When Denise Stroud gave birth to her first child 30 years ago, four months passed before the baby finally started to breastfeed normally. All of Stroud’s sisters had breastfed, and she was determined to do the same. But Stroud couldn’t figure out what was going wrong, and no one seemed to be able to help.
“I got really depressed, and it was a struggle,” Stroud said. “But I just, I wanted it so badly I pushed through a lot of pain.”
Four kids and three decades later, Stroud knows a lot more about breastfeeding than she did when she first became a mother. And she’s made it her mission to spread that knowledge to as many moms as she can. Stroud’s now an Internationally Board-Certified Lactation Consultant (IBCLC), the only one in private practice in all of Bibb County, and she helps mothers who struggle to breastfeed on their own.
Hundreds of lactation specialists with varying levels of certification provide breastfeeding support to new mothers throughout the state of Georgia. Soon, though, that number could drastically decrease, and Stroud will be one of the lucky few still allowed to practice.
The Georgia General Assembly passed a new law in 2016, which would require all lactation specialists to apply for a license in order to practice professionally. Only IBCLCs, which account for just 409 of the state’s approximately 1,100 lactation consultants, would qualify for a license under the new provisions.
“That’s definitely not enough people to take care of concerns and issues and help mothers put babies to breast,” said Kimarie Bugg, CEO of the Atlanta-based nonprofit Reaching our Sisters Everywhere (ROSE). “And then there’s several other lactation providers, such as Certified Lactation Educators (CLEs) and Certified Lactation Counselors (CLCs) and peer counselors, and so, all of those people would not be able to make a living doing this.”
ROSE seeks to bridge the breastfeeding gap between mothers of different races and incomes, and Bugg fears that the new law would make it harder for women of color and mothers in rural areas to access care. At the end of June, the Institute for Justice sued the state of Georgia on behalf of ROSE and its founder, Mary Jackson, arguing that the new statute violates the Georgia Constitution.
The state agreed to wait to enforce the law, which was supposed to take effect July 1, until after the suit makes its way through the courts. But the state has already filed a motion to dismiss the case, and now ROSE’s legal team must wade through a legal fight that will likely take three to four years, according to one of the attorneys on the case, Renée Flaherty.
Bugg, an IBCLC and nurse practitioner, said the stakes of the suit are high. Not only would the new law put hundreds of lactation specialists out of work, but it would also disproportionately impact mothers who already face limited access to health care. Most of the state’s IBCLCs, she said, practice in metropolitan areas like Atlanta, and mothers outside of major cities will likely bear the brunt of the new regulations.
In 2011, the U.S. Surgeon General recommended that communities have between eight and nine board-certified lactation counselors for every 1,000 live births. Georgia has fewer than three IBCLCS per 1,000 live births, according to the CDC.
Fewer babies breastfeed in Georgia than in almost all other states, the data also show. Just over 69 percent of Georgia babies breastfeed at least once, while the national average is more than 81 percent. Babies in only six states breastfeed less.
The state has the sixth-highest rate of infant mortality nationwide, with 7.5 deaths for every 1,000 infants born, according to the CDC. Fewer lactation specialists could put even more newborns at risk.
Different scopes of practice
Bugg hopes the state will decide to eliminate the restrictions on lactation counselors, so specialists with less training can still practice in areas with fewer or no board-certified professionals. Different types of breastfeeding aids can offer different levels of assistance for mothers and infants, she said.
“Everyone has scopes of practice, and everyone, you know, clearly knows what those are,” she said. “And so, everyone gets to work within their scope of practice so that we have an array of culturally competent lactation support providers for mothers throughout the state of Georgia so that at two and four weeks where CDC statistics show that most people in the state stop breastfeeding, we are able to prevent that.”
Bugg understands the rationale behind the new law, to an extent. As an IBCLC herself, she knows firsthand how much more work goes into the certification. Board-certified lactation consultants must complete 90 hours of lactation-specific coursework, 14 health-science related classes, and between 500 and 1,000 clinical hours before they can even take the board exam.
CLCs, on the other hand, only require 45 hours of training, offered through organizations like The Academy of Lactation Policy and Practice and The Center for Breastfeeding. The program is not nearly as rigorous as that of the IBCLC, but it’s much more accessible for those who can’t spend the time or money to earn the highest level of certification.
Consultants without board certification are limited in the treatment they provide. They can’t, for instance, refer a client to a pediatric dentist or speech language pathologist, Stroud said.
But different types of counselors can provide a range of services that areas with limited infant and maternal care severely lack. Breastfeeding peer counselors, Bugg said, have changed the landscape in many of the communities where she practices, which previously faced barriers to breastfeeding. Those without access to private practice IBCLCs would have nowhere to turn.
“The people that I serve, again, would be so affected by this, because there are peers and CLCs and CLEs that these moms are able to see, that go to their houses, that help them position and attach — things that are not clinical,” Bugg said.
In 2013, the Georgia Occupational Regulation Review Council released a report advising the state legislature not to pass the bill, which was originally proposed as House Bill 363 in several years ago.
“Based on information reviewed and developed by the Council, the Council recognizes the potential benefit of licensing lactation consultants to the citizens of Georgia, but House Bill 363 (LC 33 5015) would not improve access to care for the majority of breastfeeding mothers,” the Council report said. “The recommendation was reflected in a unanimous vote by the Council members.”
Even board-certified lactation consultants like Stroud are limited in the care they can provide. Unlike doctors, they can’t diagnose medical conditions and have to refer patients to other medical professionals when they think special care is needed.
But Stroud said IBCLCs can play a critical role in the health of both mothers and babies, and the law would allow clients to better understand what level of care their lactation counselor can provide. Parents can’t easily differentiate between the multitude of certifications, or the work that goes into them, and they might assume breastfeeding aid worker is more knowledgeable than he or she actually is.
“You could call yourself anything, and to a parent that sounds great,” Stroud said. “But there’s no comparison in the training between some of these, you know, 45-hour courses and these 20-hour courses and what the IBCLC has to go through.”
Stroud doesn’t want the new licensing regulations to make it harder for mothers to access breastfeeding help, though. She just wants them to have more information about the people offering them care.
“A really, really good CLC can be better than a sub-par IBCLC, honestly,” Stroud said. “It just depends on their passion, and how much, you know, they have done continuing ed(ucation). So there are some CLCs out there that are the only thing available in their community, and I hate to think that a mom would be denied access to breastfeeding help because that CLC is no longer able to work with that certification.”
Stroud added that breastfeeding issues are time sensitive. If problems arise, parents can’t wait multiple weeks to schedule an appointment with a specialist. And if they go unresolved, the consequences can be severe and long-lasting.
Mothers who fail to breastfeed are more likely to suffer from postpartum depression, breast cancer and ovarian cancer, Stroud said. Babies, on the other hand, might fall behind in oral development, have trouble breathing or even fail to gain weight to survive.
“We’re talking about baby’s life at stake, honestly, in some situations,” Stroud said. “A lot of moms want to breastfeed and they’re gonna breastfeed. Some of them that are passionate about it, they’re gonna want to breastfeed. They’re not going to want to use formula. And so they just keep trying and trying and trying, and they’ve got to know when it’s not working.”
Stroud wants more lactation specialists to provide such care to mothers, not fewer. So far, she’s the only IBCLC in Macon who’s registered for a license through the new state system. One person also has registered in Warner Robins. In total, Georgia’s Professional Licensing registry lists 141 lactation consultants statewide.
For now, hundreds of other breastfeeding aids throughout Georgia can still practice unlicensed while the lawsuit plays out in court.
“My hope is that the restrictions will be taken off and that the IBCLCs will just go forth with getting themselves licensed, and, you know, that they won’t try to restrict other people from working,” Bugg said.
Otherwise, mothers and babies can fall through the cracks.
“Georgia has one of the highest infant mortality rates in the country, and maternal mortality, and we know that breastfeeding is is protective of maternal health, and especially protective of infant health.,” Bugg said. “And I want babies and mothers in this state not to die.”
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at facebook.com/samantha.max.9 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.