Lactation Counselor Training Course enhances PT’s practice

Ann with her children.

Since taking The Lactation Counselor Training Course (LCTC),  Dr. Ann Croghan, PT, DPT, CLC and CAPP-OB certified says she’s changed the way she practices. Take this story she tells for example.

The mother of a 10-day-old baby reported that he hadn’t breastfed in about two days, so she started giving him a bottle of breastmilk. Ann orchestrated a laid-back feeding position where the baby laid upon his mother at about a 45 degree angle. Presumably because the mother was terribly engorged, the baby became frustrated and struggled to attach to the breast, especially positioned at this angle. Instead, Ann suggested the mother sit more upright, but not too upright, minding her significant perineal tear. After some experimentation, consideration of the mother’s and baby’s comfort against the force of gravity, and “You are good enough” praise, Ann reports that the couplet continued to successfully breastfeed.

Ann reflects that if it weren’t for the Lactation Counselor training, she would have neglected a piece of the puzzle.

“The old Ann would have repositioned for mom’s comfort without honoring the integrity of the latch,” she explains.

Ann works as a Physical Therapist at Heart of the Rockies Regional Medical Center (HRRMC) and is the co-founder of The Local Latch, an organization we recently featured on Our Milky Way. Ann says she feels so strongly about the impact of the LCTC that she’s written a letter to the Section on Women’s Health-American Physical Therapy Association (SOWH) urging all obstetric PTs to go through the training.

Ann suffered from a poor birthing experience with her first child. She had a cesarean birth for a non-emergent reason and struggled to get breastfeeding off to a good start after her high intervention birth and ill-informed maternity care staff.

“Having my baby on belly was extremely painful because her sweet little feet would hit my incision and push on my abdominal muscles which had torn during my surgery… I had a catheter for three days… I could barely walk and no one came to help me,” she remembers.

Ann goes on, “I was appalled at the level of prenatal and postpartum care from a birth prep and recovery standpoint. I was really upset about the experience I had to go through. I needed to change the system.”

So about four years ago, she moved to the small rural town of Salida, Colo. where she says she felt she could make a difference. Ann started a prenatal and postpartum physical therapy program at HRRMC to improve care for mothers.

During her time at HRRMC, she says the birth and breastfeeding culture is improving.

Families have access to a milk bank, physicians and other maternity care staff are receptive to change, and most HRRMC L&D nurses are CLCs, Ann reports.

Her physical therapy program is multifaceted.

During a woman’s third trimester, care providers focus on decreasing birth intervention and in turn hope to decrease things like perineal tearing, obstetric injury, fractures or dislocation and the primary cesarean birth ate.

Ann (right) pictured with her co-worker Dr. Sarah Hudelson, PT, DPT in front of a breastfeeding picture donated by the Chaffee County Breastfeeding Collation.

HRRMC has started to embrace physiological birth positions like birthing on hands and knees and squatting.

“We have supportive physicians and a low tear rate,” Ann comments.

Ann also conducts postpartum day one physical therapy visits in the hospital. HRRMC may be one of the only maternity care hospitals providing this service, she says.

When Ann started the therapy program, this is the component she first focused on.

“It’s easy to rationalize why someone who just had surgery should have PT,” Ann says of women who have a cesarean birth.

This visit focuses on things like bed mobility, proper breathing techniques and muscle strengthening.

“More importantly we educate them on what’s common but not normal and how PT can help,” Ann explains.

PT can be beneficial for conditions like leaking urine, leaking fecal matter, diastasis rectus abdominis (mommy tummy), pelvic pain, pain with intercourse, cesarean birth recovery, perineal tear recovery, prolapse.

The last step is a six week postpartum visit for a pelvic floor muscle assessment, biomechanical assessment, and a plan for safe exercise progression. All PT services are covered by insurance.

Ann and her colleagues are in the process of implementing a protocol of promoting lymphatic drainage and proper spinal/rib mobility in order to see if they can decrease incidences of mastitis. Ann hypothesizes that immobility leads to compression of the lymphatic system, increasing the risk of mastitis.

You can connect with Ann here and follow The Local Latch blog.

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