Linda M. Hanna, RNC, MSN/Ed., IBCLC is the founder of My Nursing Coach: The Mobile Breastfeeding Center which has served over 40,000 families since its launch in 2010. We are honored to share her reflections this week on Our Milky Way.
Hanna discovered her affinity for working with moms and babies over four decades ago during nursing school. She trained with the UCLA Extension program in the early 1980s and then went on to continue with more advanced training at the Lactation Institute with Chele Marmet and Ellen Schell and completed the IBCLC exam in the 1990s. She’s currently an Advanced Lactation Practice Course student with Healthy Children Project.
“When it came time to look at the next level of credentialing for my professional growth and personal development, I found that the Healthy Children Project had the professional staff that I wanted to learn from and gain more knowledge and insight into the professional role of the RN/IBCLC,” Hanna shares. “[They] have the history and professional background and credentials that I aspire to attain. I want to be part of something that continues to advance the degree and credentialing programs that align with some of my philosophies and this program and the team members made me feel this would be the right fit for me.”
Hanna, a life-long learner, looks back over the course of her career, and describes some of the significant changes she’s witnessed within maternal child health.
In the past women were encouraged to look toward the birth of their baby with excitement and anticipation. Controlled breathing and meditation with physical and emotional support was how most women entered the last few hours of pregnancy as they prepared to enter the process of labor and birth.
Now fear seems to drive many families to make choices about the way they will give birth, as if they somehow do not have the ability or capacity to handle the pain of contractions and giving birth: a right of passage. Women may not even prepare for childbirth but instead prepare for a medicated birth or a birth with regional anesthesia. Parents are concerned about what might happen to them or their infant if they do not follow hospital policy, and the physicians and midwives are often concerned about what the hospital might say if the mother is allowed to labor ‘too long’. Many expectant women have complicated pregnancies and that leaves room for high risk situations to present which also may cause staff nurses and providers to be anxious about the outcome and so there is a lot of discussion and planning before the baby is even born.
Women have more interesting and involved previous diagnoses than in the past. This requires the provider to be more knowledgeable and comprehensive with their care plans and educational provisions. The level of care that is needed to provide holistic care and well-rounded wrap-around support is now higher than ever before and requires that the [care provider] be trained in more advanced practice than in years past. As medical and surgically compromised clients enter the breastfeeding world, they need to be made aware of some of the possible challenges they might face as they move through the lactation journey.
On a positive note there are birthing options that did not exist in the past. Many birthing centers are now available and midwives are able to [assist] physiologic births again, as they did in the 1980s and 1990s, and some hospitals have chosen to allow for more natural birth with a doula at the bedside.
The My Nursing Coach platform was imagined, designed and developed to consider all of the intricacies of feeding a baby in a modern world. Its development pays special attention to the health and wellness of the mother recovering from birth and who is responsible for so much.
Home care is a very special type of support service. I have always felt that when someone is in the safe and comfortable surroundings of home with their personal items close at hand they are able to concentrate and learn new skills. Hospital experiences with lactation consultants and feeding experts are timed and many times not long enough to complete a full feeding start to finish. The nurses have many tasks to perform in order to have a timely discharge for mother and baby. Knowing that I was both the nurse and the lactation consultant I felt the pressure of sending families home who might have needed more time for learning and practice. Doing home visits allow me to have more time to spend with the family, completely devoted and dedicated to them and their needs.
[Early on,] I was concerned that the mother was going home with an infant that she had just learned to feed, had to care for herself as she recovered from childbirth, and was not going to see her physician for a few days or longer, and I wanted to make sure that they were all doing well. The infant feeding issue was front of mind for me. I knew that jaundice was always possible and infant and maternal separation were going to interfere with normal nursing patterns. I started checking the baby’s bilirubin levels using a bilimeter and had phototherapy beds on my truck as well so I could start home light therapy as ordered by the physician when the level indicated care. I also was able to address any healing issues that the mother was concerned about and then report to the OB MD any findings I had that were relevant and needed to be addressed. I carried a blood pressure cuff with me on the truck as well so that any need for blood pressure monitoring could be provided and reported back to the primary doctor. The truck was a mini office with all of the necessary equipment to conduct a full infant and maternal exam as needed.
The platform has changed since its launch. My Nursing Coach has grown their team, including an operations and technology manager Melissa Hanna, daughter of Linda Hanna. Linda Hanna goes on to describe how the platform has evolved.
In 2014, we branched out and started seeing mothers and infants in an office setting so that the pediatrician could also see the newborn at days two to five of life and address any concerns they had about the dyad. We expanded our home care services to a large community hospital and provided home phototherapy to reduce readmissions, save dollars and keep mothers and infants together at home. All parents received lactation support as well during these appointments.
Melissa had the idea to power the program at first with the technology of medical charting and messaging features so that there was a way to communicate everything we did with the parents so the physicians were aware of the progress. After that program was up and running she realized that the way the providers communicated was a valuable service and designed a dual chart system and we were able to provide wrap-around services that allowed dialogue between the many care providers caring for this family. People started showing interest in maternal/ child care programs that addressed the needs of both patients and she went out and demonstrated the platform. Then she realized this was an important part of the overall health and wellness of both the expectant and newly delivered family and the program started to grow. She runs the company and all of the parts of the operational side of the program and I support her by managing the clinical portion with a team of nurses and other healthcare professionals and lactation consultants who provide direct patient care. When we don’t agree on things we try a new way of working through them until we end up with a manageable solution that allows us to deliver high quality care.
Hanna says more about curating the right lactation care team.
Anyone who wants to work with new mothers and infants finds this work satisfying and rewarding. The work of the lactation consultant is hard at times and requires the work of a detective, seeking out information, looking for clues and then creating a plan that meets the needs of the participants, parents and children. We have high expectations of our team members. Our clients are diverse and have varying needs and desires. We have to be mindful of their wishes and plans, while staying true to the purpose of our work. To find the right consultant we need people who are open to always learning and growing in their field. We like to find individuals who care about women’s wellness through the childbearing years and look at each case as an individual experience. No two birth stories are the same and they should be cared for differently. We want a cultural fit for them so that work feels meaningful and they are in a place that respects them and their needs. We strive to make the work environment a place to share ideas and thoughts so that the company can grow and work better each day. This employee wants to be part of something special that makes a difference for themselves and the parents and families they care for. To find this individual is hard because they also have to possess the hand skills and detective skills needed to do this lactation work with compassion and consideration.
Earlier this year, My Nursing Coach joined forces with Providence Saint John’s Health Center.
Our company was asked by one of the medical staff members to consider providing direct patient care with a complete program including the wrap-around services we had been providing for all of our other programs around the country. We were able to offer a contract that allowed for both inpatient and outpatient services as part of the package all expectant and newly delivered families received as part of their care model. We make every effort to see every newly delivered mother / baby dyad within the first 24 hours after birth and then as many times as needed while hospitalized. We see any newborn in the NICU as well as all breastfeeding or milk expressing people who have been re-admitted for a medical or surgical complication. In addition we will see any parent who is brought to the Emergency Room for a lactation or infant condition as needed. Daily rounds, 7 days a week and holidays are staffed with at least one IBCLC. We have had a very successful and positive experience to date and have seen over 900 dyads so far this year. We do staff nurse and associate staff training and work closely with the clinical team, directors and medical staff to ensure our team is following guidelines, policy and procedures and attend staff meetings and Task Force meetings monthly. We would consider other medical center programs and have learned so much from this experience. Having started hospital based lactation programs many times over in the past I felt confident that we would be able to meet the needs of the organization while taking a new approach, using our technology to expand our support beyond the hospital doors and it has been wonderful for staff and for the parents / families we serve.
Hanna shares what excites her most about lactation care in our nation, and on the flip, what worries her most as well as some advice for new care providers.
I can see that this profession has a place at the big table and a very important role to play in the maternal and child health care continuum. This means that we are part of the team that provides the care and support needed to ensure that infant feeding and maternal health and wellness are in the forefront of everyone’s mind. We are now recognized for our contributions to maternal health and wellness, physical and mental health and prevention of morbidity and mortality.
Another exciting thing about the profession is that the learning opportunities continue to grow and the offerings are much more detailed and tailored to the needs of the lactation consultants in the various specialty areas that we each work in. In the past, the education and development programs to grow one’s knowledge base were less available and accessible. Many of the program fees were high making it difficult for many consultants to attend training especially when travel was necessary. Now with virtual and online programs and classes most consultants are able to do continuing education classes on their own timeline as well as at home or in the office.
The most worrisome part of the field is the lack of support and direct hands on training that is available to newly trained consultants. The way that one becomes a proficient high functioning lactation care provider is by direct patient care, hands on practice and hours of interviewing families and providers to get the history needed to form a complete plan of care. Without proper guidance for skill development, history taking and care plan development the consultant is left to figure these things out on their own. This diminishes the ability of the provider to offer excellent care, mostly due to the fact that they do not have the training needed to be the detective and uncover information vital to their case. This training comes from hours of side by side clinical exposure with a highly skilled consultant with thousands of hours of work in both low and high risk patient care settings.
One of the things I try to share with new staff is to be aware of the client’s social and emotional history just as clearly as you are about her passion to provide human milk for her baby. Without a proper medical and surgical history as well as a proper mental health evaluation, even as a basic part of the medical chart, the clinician will not be able to fully understand or meet the needs of their population. Ongoing learning opportunities as new advances in healthcare present is essential for excellence in patient care. While everyone, including myself will run into situations where things are missed or care is missguided based on the lack of consideration, a well seasoned and knowledgeable consultant will be able to navigate back to a clearer understanding and presentation of their plan when they are well trained and have up to date knowledge in a specific area. Owning up to any issues that present themselves, including when necessary, an apology for any misunderstanding is critical to maintaining long term care and repeat appointments. The skilled and competent clinician can show up in a way that offers compassion, respect and shared understanding of the needs of the family.
I find that there is a strong desire among many women, and some men as well, to support and guide newly expectant parents and their families as well as post delivered parents in ways that show their dedication to infant feeding. Many consultants have been heard saying how much they love helping moms breastfeed. The mother and her medical history as well as the infant and their own medical story must be addressed with attention to detail and a desire to bring together all of the other healthcare professionals that can enhance this family’s overall well being. It is not enough to just want to help mothers breastfeed. There has to be a commitment to the family and all members of the breastfeeding dyad or triad that their needs, desires and wants are always top of mind and the purpose for our work.