Although the Babylonian Talmud tells the story of a poor man whose wife died
soon after childbirth and, unable to hire a wetnurse, was miraculously able to
nurse the baby himself, breastfeeding is generally a woman’s business. And in
almost every case (except a handful of male pediatricians, speech therapists and
others in the US who double as lactation consultants), giving advice about
breastfeeding is a woman-to-woman business.
Surprisingly, the Health
Ministry in Jerusalem has not gotten involved in supervising lactation
consultant professionals who, as internationally recognized IBCLCs
(international board certified lactation consultants), have to meet rigorous
registration standards and even face periodic re-certification. The
organization, divided by continent, serves as the “gold standard” in certifying
experts in the field.
EARLIER THIS month, International IBCLC Day was
marked in Israel by Israel chairman Evi Adams and other members of the Israel
Association of Certified Lactation Consultants, along with colleagues around the
world. No national events were held to mark the day, but each consultant was
free to organize local ones. “We are trying to get official Health Ministry
recognition,” said Jessica Billowitz, who came on aliya from the US 18 years ago
and has been a certified IBCLC since 2000. “To get certified, you need up to
4,000 hours of training and must pass a seven-hour exam. Re-certification is
carried out after five years to make sure the consultants are updated on a
regular basis,” she said. Billowitz notes that certification has been in
existence around the world since 1985 and that today, there are some 20,000
Although recognized globally, IBCLCs are surprisingly not
recognized as professionals in Israel. “We are trying to get professional
recognition,” she said in an interview. “There are nurses who are nursing
counselors in hospital maternity wards and who are paid by hospitals for their
job. There are also some salaried inhospital IBCLCs, but women remain in
hospital obstetrics and their babies in neonatology units for just a few days.
Most of the breastfeeding problems begin when they have gone home,” said
IBCLCs more often work privately via home visits, as lactation
consultants are not included in the basket of health services. It can thus cost
NIS 400 per consultation.
In addition, there is the La Leche League,
which is run by devoted volunteers and by mothers who have experience. In the
US, there are midwives who are registered nurses and also work as lactation
Billowitz explained that IBCLCs stand for knowledgeable and
experienced members of the maternal health team who have specialized skills in
breastfeeding management and care. But they do not have to be registered nurses
THE CERTIFICATION program offers the only credentials in
lactation consulting, and is available globally. “IBCLCs have passed a rigorous
examination that demonstrates the ability to provide competent, comprehensive
lactation and breastfeeding care.
Attainment of the IBCLC credential
signifies that the practitioner has demonstrated competence to work together
with mothers to prevent and solve breastfeeding problems, and collaborates with
other members of the health-care team to provide comprehensive care,” said
Billowitz. “This supports, protects and promotes breastfeeding, encourages a
social environment that supports breastfeeding families, and educates families,
health professionals and policymakers about the far-reaching and long-lasting
value of breastfeeding as a global public health imperative.”
who become Israeli IBCLCs are nurses, midwives, dietitians, physicians and
experienced breastfeeding support counselors. IBCLCs work in a variety of
settings including hospitals, clinics, physicians’ offices, neonatal intensive
care units, human milk banks and private practice.
With a focus on
preventive health care, IBCLCs encourage self-care, empowering parents to make
their own decisions. IBCLCs use a problem-solving approach to provide
evidence-based information to pregnant and breastfeeding women and make
appropriate referrals to other members of the healthcare team. The IBLCE (the
International Board of Lactation board of examiners) has established
professional standards for IBCLCs and must renew their certification every five
years, either through continuing education or by re-examination.
training and seven-hour certification exams for IBCLCs are in many languages,
with the comprehensive tests given around the world on the same day.
can’t just decide to take the exams. There are pathways that make you eligible.
Some are already in healthcare professions, others worked in maternal and child
health, infant growth and have a background in anatomy, physiology, biology,
infant growth and development,” she said.
Lactation counselors don’t have
to be mothers, or even be married. They don’t have to have breastfed
Some were even unable to breastfeed, said Billowitz, but all are
well trained. Women who consult may have started to breastfeed and given up, or
not done it at all.
There are women who underwent breast reduction but
are counselled on how to nurse babies. Women, she said, want to do the best for
their babies. “Consultants come in all ages; many of them are already in their
60s, but there is a new generation as well. Although I have over a decade’s
experience, I am one of the younger ones.” Every child, she continued, “deserves
the best chance in life.
Guilt is a catchword. Many mothers feel guilty.
Women must reach their own goals." IN DEVELOPING countries where water supplies
are at risk of infection, even HIV carriers are advised to breastfeed, but in
developed countries, the relatively small number with HIV are advised not to
breastfeed because AIDS infection from mother to child is almost entirely
In the Western world, returning to work soon after delivery
is common, especially in places like the US.
There is more time to rest,
form bonds and breastfeed for a long time in Scandinavian countries, but
significantly less in Israel. And once Israeli women go back to work, some have
difficulty getting permission to nurse on the job (if there is access,
especially a creche on site) or to pump milk.
“Mother’s milk is amazing.
It can stay unrefrigerated for eight hours – or even better, be put in a cooling
pack and then refrigerated or frozen. It is not esthetic or sanitary to pump in
bathrooms, but it can be done in supply closets, storerooms and the like, “and
even a friendly boss doesn’t mind his room being taken over for 20 minutes,” she
said. Employers are gradually understanding that giving women time to pump milk
quietly and securely pays off, as their babies are healthier and less likely to
be sick, said the IBCLC. “Even if they look at the dollars and cents of the
thing, it makes employees more loyal to their workplaces.”
women come back to work, they should try – with professional help if necessary –
to pump milk and feed the baby with it from a bottle.
They will find it
very stressful if the baby refuses to take a bottle of breast milk. Spoonfeeding
is very tiring and frustrating. “But when I counsel women about this from the
beginning, it usually works out.”
Billowitz recommends a slow-flow bottle
nipple so the infant does not guzzle or choke. Breastfeeding is slower and
requires more effort for a baby, but can take as little as 20 minutes, depending
on the individual. If they have an ordinary nipple, they can get used to it and
get lazy, she said. But all babies should always be held, whatever the source of
feeding, and not just have a bottle propped up. It is the best emotionally to
have body-to-body contact.
Children benefit from nursing, as there are
fewer speech problems because of proper sucking. There is much more known from
ultrasound scans, said Billowitz, “as we understand the movement of the tongue
and show that it is a different type of sucking.”
Asked about the views
of the haredi community, Billowitz said it is generally very positive to do it
anywhere, even in public – as long as it is carried out with the mother
well-covered. “There always are a few crazies from any sector,” she added.
Breastfeeding for a relatively long period saves the family many thousands of
shekels in formula, bottles and sterilization costs.
The IBCLC was very
upset to hear that when former prime minister Ehud Olmert was mayor of
Jerusalem, he was known to turn city council meetings into “an official smoking
room” that was actually illegal because they were attended by nonsmokers as
well, and that at least one city counselor who gave birth not long before was
forbidden to nurse her child modestly during council sessions.
that breastfeeding, pumping and having baby-friendly workplaces, including a
clean place for diaper changing and other activities, should become a norm not
only at work but also in shopping malls and other public places. Change can
slowly be achieved, she said.
There are some voluntary breast milk banks
in Israel – mostly run and the milk supplied under supervision by haredi women –
but in the US, prescriptions are written, just like blood infusions are, for
babies who need breast milk, which is pasteurized and provided by mostly non-
Jewish, healthy women. They are not for profit and located in places like
Austin, Texas and Boston.
ALTHOUGH AIMING at more common and longer
breastfeeding, Billowitz does not want to make women who use formula feel
guilty. But neither does she want to encourage formula companies, who for years
have subsidized their supply to newborns in hospitals and openly or
surreptitiously given new mothers gift sets of formula to encourage their
continued use at home. “A millionaire family’s baby fed with commercial baby
formula has a poorer diet than the poorest baby who was breastfed,” she
Billowitz was not pleased by recent ads from a charity
organization that gives baby formula to needy mothers without carefully
determining whether they could more easily and beneficially breastfeed their
The IBCLC said that while not every mother is able to
nurse, if more mothers were informed of lactation care, we would see
breastfeeding rates increase. It should be included in the basket of health
“But the pressure in hospitals to give advice on breastfeeding
is so high; there could be 30 women being advised in a couple of hours. More
time is needed at home.” She notes that one health fund, Clalit Health Services,
reimburses members, but most of the others do not. There are some supplementary
health insurance policies to get additional services.
“I like to see the
mother with her baby in a natural environment, so I make home visits. I have
helped mothers nurse after having twins, and it can be done even with triplets,”
Fathers can give bottles of pumped breast milk. It can
give women time off to rest. But fathers don’t have to do it, and there are many
ways for them to bond with babies, such as playing and giving baths, she
Dr. Lisa Rubin, the US-born gynecologist and obstetrician who a
few years ago became head of the ministry’s department of maternal, child and
adolescent health is well aware of the fact that lactation counselors in Israel
do not meet rigorous requirements and undergo mandatory certification as IBCLCs
do. In addition, breastfeeding conditions and recognition of the rights of
mothers and their babies are not universal here.
division head Dr. Shosh Riba issued an official directive last December stating
that by 2013, there must be lactation counselling by a registered nurse in every
hospital. She also set up an advanced course including over 100 nurses. The
ministry has also held shorter courses for tipat halav (well-baby) clinics. But
there is the right of “freedom of occupation,” so the ministry has not yet set
universal standards and official certification, she said. These courses are
significantly less rigorous than IBCLC standards.
Rubin also concedes
that the ministry’s Mabat surveys of newborns’ health and feeding are inadequate
and cover too small a population group; she can’t even say how many infants are
breastfed when their mothers return to work. “No, I am not yet satisfied with
what is done; there are always financial and bureaucratic
One hopes when the ministry finally catches up and societal
changes are established and automatic, the current crop of newborns will not be
in high school.