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Information for Medical Students, Residents and other Learners at the Herzl-Goldfarb Breastfeeding Clinic

GUIDELINES:

Welcome to the Herzl-Goldfarb Breastfeeding Clinic. We hope you enjoy your experience with us.  

ABOUT THE CLINIC:

We are an multidisciplinary referral-based clinic, with physicians and lactation consultants working together to solve complex breastfeeding issues.  Our patients have already been seen by one or more health care professionals before they come to us, and may therefore present with complex or unusual problems.  Our referrals come from a variety of sources, including family physicians, specialists, postpartum nurses, CLSC nurses, midwives, lactation consultants, dieticians and breastfeeding support workers.

Our mission is to provide breastfeeding families with lactation services based on excellence of care and current research, educate professionals in lactation management, and contribute to the field of breastfeeding research, within a multidisciplinary setting.

YOUR ROLE:

The Breastfeeding Clinic receives observers from many backgrounds, including medical students, residents and fellows, but also nurses and nursing students, midwives, lactation consultants and other health professionals training to be lactation consultants.  Each type of observer may have different levels of experience, thus different roles and objectives.

Remember to always wear a name tag, and introduce yourself to the mother when you meet her, stating your name and role.

Our patients may be at a vulnerable place when they present to the clinic, especially if their breastfeeding problem has been long-standing, if they have had to repeat their story to many health professionals, or if they have not been able to receive adequate help yet.  Therefore, please be sympathetic and respectful when approaching them.

Your role in the clinic is to learn about various breastfeeding issues and solutions, while observing and participating in patient encounters.  Your level of active participation will vary based on your experience and length of stay with us.  Since the histories and physicals are very specific to the types of patients we see, you may find it useful to simply observe a few clinical encounters at first. Feel free to shadow both the physician and lactation consultant(s) working on a given day.  You will see that each type of health professional works differently.  

Once you feel more comfortable, you will be given the option of conducting initial histories with a supervising physician present, or alone and review with the physician afterwards (this is applicable only for medical students, residents and fellows).  Medical students, residents or fellows who spend a longer time in the clinic, such as during a 1-month breastfeeding elective, or once a week during a 6-month fellowship, for example, have the opportunity of seeing more patients on their own while being supervised by staff.  Before seeing any patient on your own, please make sure the supervising physician is aware, and reviews the case completely before the patient is discharged from the clinic.  This includes reviewing and co-signing all prescriptions which may be written before they are given to the patient.

OBJECTIVES AND SUBJECTS COVERED:

The following is a list of subjects that we hope you will cover during your stage in the Breastfeeding Clinic.  Most of these subjects will be discussed during the Breastfeeding teaching session during your 2-year residency period.  Feel free to ask us about any of the subjects below (or other subjects not listed below) if you would like more information.

The risks of non-breastfeeding.

Normal breastfeeding patterns in terms of mothers and infants.

Normal infant attachment to the breast.

Possible problems that may occur while breastfeeding, such as:

  • Breast/nipple pain, including inadequate latch or attachment of infant to the breast, infections (thrush, mastitis, other bacterial infections), vasospasm.
  • Tongue-tie or ankyloglossie and frenotomy
  • Inadequate infant weight gain and/or insufficient breastmilk supply
  • Difficulty or refusal to latch/feed
  • Breast lumps, including blocked ducts, abscess and other types of lumps.

We encourage you to look through our "Articles" binder and "Policy and Procedures" binder while you are with us. 

We also have patient handouts on various topics that you can refer to during your time with us.  You are encouraged to do your own reading, using articles and books that are available at the clinic.  If you are doing a breastfeeding elective, or if you are particularly interested in breastfeeding medicine, you will be asked to do a small written project on a topic of your choice.  The clinic is also conducting various research projects and welcomes any interest from residents and fellows to participate in these studies, or initiate new initiatives.

Please feel free to ask questions, and to let us know how we can best meet your learning objectives.

We look forward to having you with us and wish you a great learning experience!

USEFUL ARTICLES:

AAP Breastfeeding Guidelines, 2012

CFPC Infant Feeding Statement, 2004 endorsed 2011

Lancet Breastfeeding Series 1: Breastfeeding in the 21st century: epidemiology, mechanisms and lifelong effect.

Lancet Breastfeeding Series 2:  Why invest, and what will it take to improve breastfeeding practices?

Breastfeeding and Future Health, Schack-Nielson, 2006

Risks of Not Breastfeeding, Stuebe, 2009

Breastfeeding and Maternal CVS Risk, Swarz, 2009

Domperidone review and meta-analysis, Osadchy, 2012

The Maxillary Lip Tie, Kotlow, 2013

Tongue-tie and Breastfeeding: A Review of the Literature, Edmunds, 2011

Academy of Breastfeeding Medicine Protocols:

Ankyloglossia

Breastfeeding Friendly Office, 2013

Co-Sleeping and Breastfeeding, 2008

Galactogogues, 2011

Mastitis, 2014

Milk Storage, 2010

Peripartum Breastfeeding Management, 2013

Persistent Pain and Breastfeeding, 2016

Supplementation, 2009

 

USEFUL WEBSITES:

Academy of Breastfeeding Medicine

International Lactation Consultant Association

Association des consultantes en lactation diplômés de l'IBLCE 

Infant Risk Centre (Dr. Tom Hale's website on safety of medications during lactation)

Lactmed