Breastfeeding and the Registered Dietitian [updated Oct 2011]

[October, 2011 updated links. See also notes at the end of the post]

Welcome! This post is part of the Motherwear Breastfeeding Blog's September Carnival of Breastfeeding and this month's topic is "learning about breastfeeding." In this post, I'd like to address breastfeeding in the formal education of a registered dietitian (RD), as well as the potential role of the RD in breastfeeding promotion.

For those who are unfamiliar with the RD credential, in the United States, registered dietitians are food and nutrition professionals who have completed an approved university degree, fulfilled certain practice requirements (also from an approved program), and passed a national exam. Furthermore, an RD is required to have 75 contact hours in approved continuing education over a five year period. So as you see, there is much on the plate of a dietitian. Just as the association between food and health is actually quite complex, the field of dietetics is very broad. So breastfeeding easily becomes such a small part of a dietitian's education and work.

Breastmilk is the most basic of foods -- infinitely and amazingly rich in nutrients, totally customized for the rapid growth and development of the human infant, and produced within the mother's own body. As basic as breastmilk is, it is far from simple. There is much more to breastfeeding than the milk alone. Yet somehow, this idea has been buried under other important dietetic concepts.

The amazing and somewhat miraculous properties of breastmilk might suggest that few if any obstacles exist in the mother-child nursing relationship. Unfortunately, this is not so. While most people believe that the act of breastfeeding is easy, there are several physical factors that could interfere with a positive breastfeeding relationship. Dietitians are trained to consider the challenges to healthy eating practices. Yet, when it comes to breastfeeding, it is common for a dietitian to be first confronted with obstacles to breastfeeding through personal experience. Although I have found breastfeeding to be relatively hassle-free, Margie Hirsch, a dietitian in family and consumer science, is undergoing a completely different experience. Margie stated, "Being a dietitian, I was so excited to provide breast milk to my infant because of all the benefits we learned back in college! I had nothing but problems from day one." Margie has persevered to breastfeed her two month old, yet she has gained empathy for mothers who struggle to breastfeed.

In a position paper titled "Promoting and Supporting Breastfeeding", the American Dietetic Association encourages "universities to review and update undergraduate and graduate training programs."* Yet I believe that much progress is still needed in this area. I'm not advocating new courses on breastfeeding, but simply more predominance within the general dietetics subjects (though new courses would not be a bad idea). I believe that future dietitians should understand that there is more to breastfeeding than the fact that it provides the best infant food. A greater emphasis is required to:

1. understand the barriers to the availability and supply of breastmilk,
2. grasp the impact breastfeeding can have on the health of a society, and
3. realize the valuable role a dietitian can have in breastfeeding promotion.

Currently, dietitians are placed in intermediary roles in support of breastfeeding. Neonatal and public health dietitians work regularly alongside lactation consultants, often in a collaborative team of health professionals. Registered dietitians desiring a more direct role should be encouraged to become lactation consultants (such as IBCLC). Nonetheless, it is not always necessary for dietitians to become lactation consultants in order to positively impact breastfeeding rates and duration. While it is unlikely that all dietitians will come in contact with pregnant and breastfeeding mothers through their employment, ninety-seven percent of dietitians are women. Many are or will be mothers and will be friends with other women who are or will be mothers. Therefore, any registered dietitian could be a unique and valuable resource to the breastfeeding community. One can loan their expertise by volunteering as a peer counselor, attending breastfeeding support meetings, and joining statewide or area-wide breastfeeding task forces. These are effective ways to extend the reach of a dietitian beyond the workplace. It adds value to the dietetic profession and strengthens the message of what a healthy lifestyle is all about.

In every profession, regardless of the level of one's expertise, there is always much to be learned. Dietitians need to learn more about breastfeeding because of its far-reaching health implications throughout the life cycle. More advanced training opportunities are needed for dietitians who desire more direct involvement in lactation support. My hope above all else is that all dietitians will fulfill their unique and valuable role in breastfeeding promotion, big or small.

I believe every little bit counts.

Special thanks to my husband Stan, Kimberly Mack, MS, RD, LDN (a neonatal dietitian), Michelle Scott, MA RD, IBCLC (in private practice), and Margie Hirsch MFCS, RD, LD for their time corresponding with me as I was pulling these thoughts together. Although they have contributed to my thought, this post does not necessarily represent their opinions.

Related reading:

• More about Registered Dietitians at the American Dietetic Association's website
• The American Dietetic Associations position paper on promoting and supporting breastfeeding.
• Also, Tanya at Motherwear Breastfeeding Blog has also written a carnival post on different training programs and certifications for lactation support.

Other carnival participants:

• Sinead at Breastfeeding Mums: The Perfect Breastfeeding Teacher
• Angela at Breastfeeding 1 2 3: Breastfeeding in Education
• Lauren at Hobo Mama: Breastfeeding Education
• Casey at Beautiful Letdown: How I learned to Breastfeed
• Kate at Momopoly: My mom-in-law, the lactation consultant
• Jenny at Babyfingers: Let's take our perverted society to school
• Jenna at Stop, Drop, and Blog: With a little help from my friends, books, and professionals
• Kate at Poked and Prodded: You have to prepare for breastfeeding success

* the link is to the position paper updated in 2009, but the quote is from the position paper at the time this blog post was written. However, the 2009 position paper states something similar: "Conduct critical internal review of undergraduate  and  graduate  dietetic  training  programs  to  ensure that  lactation  physiology,  breast-feeding management, and cultural competence  are  incorporated  into curriculums." (p.13) The paper also encourages RDs to obtain a lactation-related certification as well as collaborating with other lactation professionals. (also on page 13).