Nurse and IBCLC, Rochelle Caldwell

It was great reconnecting this week with my old friend and colleague, Rochelle Caldwell. Now let me rephrase that: we are not old, our friendship has just happened to span 43 years.  Rochelle is a labor and delivery nurse and an Internationally Board Certified Lactation Consultant, and since that’s a mouthful, let’s just say an IBCLC. She was inspired to pursue this career path by another nurse, also an IBCLC who witnessed her interactions with postpartum mothers and recognized her potential. As a labor and delivery nurse, she is uniquely poised to observe newborn baby behavior, provide lactation education, and advocate for the breastfeeding needs of the mother/baby dyad.  According to Rochelle, empathy is the most critical characteristic a nurse can have when working with breastfeeding families. It requires the ability to understand their perspective and meet them where they are.  In the five-minute snippet: I’m cold just thinking about it! For Rochelle's bio, visit my website (link below).
International Board of Lactation Consultant Examiners: https://iblce.org/
International Lactation Consultant Association: https://ilca.org/
The United States Lactation Consultant Association: https://uslca.org/
National Lactation Consultant Alliance: https://nlca.us/
Monetary Investment for Lactation Consultant Certification:https://milcc.org/

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Transcript

[00:00] Michelle: It was great reconnecting this week with my old friend and colleague, Rochelle Caldwell. Now, let me rephrase that. We are not old. Our friendship has just happened to span 43 years. Rochelle is a labor and delivery nurse and an Internationally Board-Certified Lactation Consultant. And since that's a mouthful, let's just say an IBCLC. She was inspired to pursue this career path by another nurse, also an IBCLC, who witnessed her interactions with postpartum mothers and recognized her potential. As a labor and delivery nurse, Rochelle is uniquely poised to observe newborn behavior, provide lactation education, and advocate for the breastfeeding needs of the mother-baby dyad. According to Rochelle, empathy is the most critical characteristic a nurse can have when working with breastfeeding families. It requires the ability to understand their perspective and meet them where they are. In the five-minute snippet: I'm cold just thinking about it. Well, good morning, Rochelle, welcome to the podcast.

[01:28] Rochelle: Thank you. It's nice to be here, Michelle.

[01:33] Michelle: It is. We have been friends and colleagues for quite a long time, way back, way back in the day in the 1980s when I was just a child. And then we had another great connection when I became a mom at 22, you were my labor nurse.

[01:59] Rochelle: Yes. And you were very fortunate to be in labor and delivery when the air conditioning went out, I believe. Were you there that day? Were you there when the air conditioning went out? It did that so many times.

[02:18] Michelle: I've been there many times in that kind of old archaic hospital until we got some new digs and, yeah, there were some sketchy days where the AC went out and it was so hot and I remember the water going down, so we had no water and no ice and we had to ship in water.

[02:40] Rochelle: Yeah.

[02:41] Michelle: All the joys of working in an old hospital.

[02:44] Rochelle: Yes.

[02:47] Michelle: I'm really glad that you're here today and that we connected recently. So you're joining us today from Plains, Montana. Montana. Yes. Love it. So we connected because you flew back here to California. And so we had some coffee and we said, yeah, let's get together and do this. So thank you for coming on.

[03:14] Rochelle: My pleasure.

[03:16] Michelle: Well, you are an RN, you're a labor nurse, and you're also an Internationally Board-Certified Lactation Consultant. So that's what we're going to talk about today. But start by just telling us how you became a nurse. Why maybe what your why is and where you've worked and what you're doing now.

[03:44] Rochelle: Well, I started wanting to be a nurse when I was a very small child. It's what I always wanted to do, although I thought I'd never be able to because I had a phobia of blood. I would pass out at the side blood, believe it or not. I guess I grew up and then that wasn't an issue. And I started out in mental health as a mental health worker. And one day I was going to go to school and become certified in mental health care. And the nurse that was working with the patients and giving them the injections and stuff, she said, don't do that. Become a nurse. You have more opportunities. And I took her advice, so I was really glad I did that. And then when I was in nursing school, the first delivery I saw set my path. I knew that's where I belonged. So that's where I pursued labor and delivery. I never was sorry I did that. I love laboring and bringing in a new life to the world. It's an experience you just can't explain to anybody unless you've done it yourself. So it's amazing. And so the process of becoming an IBCLC started when I would have difficulties getting a baby latched after delivery. I would be trying and nothing would happen. So I would call for assistance, and the IBCLCs that worked in the mother-baby unit would come over and help me and explain what they were doing and show me different tricks to get the baby to latch. And one day, one of them, mainly her name is Noreen Siebeneller, said, you're so interested in this, why don't you go to school and become an IBCLC yourself? So that's where my journey began in that direction, and I did do that. I first became a CLE, which is one step towards becoming an IBCLC. And it has, I think it was 90 hours of classroom education and some clinical plus. To become an IBCLC, you have to have so many hours of mother-baby experience. So the years of working as a labor and delivery nurse made it so I had those hours. There are three different pathways to becoming an IBCLC, and they all involve different amounts of education, different hours, and different mentoring hours as well. From there, it took a while, but I became an IBCLC.

[06:56] Michelle: Okay, well, I love hearing the stories, first of how nurses are inspired to be nurses. Some of them, like you knew at a very early age. Some nurses started out in a different major, and then maybe a friend of theirs or somebody saw something in them and said, I think you'd be a great nurse. And then they changed their whole pathway. I love hearing stories of how that whole journey came to be. So your path to an IBClC, when you were in school for this specialty, was there anything that. I mean, I'm sure you learned a lot, but was there anything that was just unexpected in terms of things that you didn't know?

[07:47] Rochelle: I would say yes. One of the things I really didn't realize was that babies are programmed to know where to go. So if you leave them, if they have not had a traumatic experience during birth, which we can't predict, they know what they're supposed to do, and we have to give them time to be able to accomplish that. And I had no idea that was real. I really didn't. I can remember watching a movie called Blue Lagoon, and it had. I can't remember her name anyway. And she had the baby, and they were trying to feed it carrots and stuff, and she held the baby up, and the baby went to the breast. And I thought, oh, that's silly. It wouldn't really happen, but it really does, which I thought was amazing. I don't know who was the person that brought that into the movie, but it was true. It was truly true. And there were other things that I found out that were amazing that we are programmed to know at birth. Truly amazing.

[09:12] Michelle: That's so funny that you made that connection. So now you're an IBCLC, and you're also a labor nurse. And so you're using that knowledge, the skills, the education that you've learned in your job as a labor nurse. And you talked about if you give the baby time, and in the hospital world, we are governed, everything we do is very time-driven. And so what are some of the challenges that mothers and babies face in terms of breastfeeding inside a hospital?

[09:55] Rochelle: As you said, time is of the essence, and you can kind of bypass that time by doing everything that you can without disturbing that connection of skin-to-skin with mom and baby. So taking the temperature and doing all that you can with the baby right where it needs to be on the mom, it is amazing how much that skin-to-skin contact makes a difference for the baby. It helps regulate their temperature, their blood sugar, their respiratory rate. It's truly amazing to watch that normalize when the baby is skin-to-skin. So allowing that baby to stay there as much as possible, do everything that you possibly can to keep the baby where it needs to be, there are vaccinations that need to take place, eye ointments and those things. And a lot of it can be done without breaking that connection. It's a little bit more difficult than picking them up and taking them away, but it's worth it for the baby.

[11:08] Michelle: Yeah, it's a really special bond, and when you see it in action, it really is something to behold. And I think we interfere so much with all of our tasks that we need to do. And I remember, and you might remember this, too, definitely. We taught Birth and Beyond together, so Birth and Beyond California. When we were bringing that to our units and teaching all these new principles about uninterrupted skin-to-skin, we had to have some difficult conversations with some of the medical providers. I remember kind of the routine was that the baby would be born, and we take the baby over to the warmer, and we do all the things, and we weigh the baby and do all the meds and the eye ointment and just like you mentioned, and then when the baby's really disturbed, and then the pediatrician comes and does the exam. Right. And so we would be putting these babies skin to skin. And I remember the first time the pediatrician came in and wanted to remove the baby so that he could do his exam, and I said, oh, no, this baby is skin to skin, and you're going to have to come back later. And let me tell you, it took a lot of guts to say that and to advocate for that dyad. Right. But it was totally worth it. And I made a joke of it. I was like, I'm sure there are some other kids that you can see. I'm sure you can make a note or something and come back, but we're not going to disturb this special bonding that's taking place. And I'm sure you've had to have some of those difficult conversations as well with providers to just kind of back off and let them be together.

[13:06] Rochelle: Absolutely. There are several that I can remember. These were pretty stressful moments for me, anyway. It's hard when you advocate for a patient. It's so important, though, to do that. They don't have anybody else fighting for them. So it's really important.

[13:29] Michelle: So important. Okay, so what are some of the most helpful resources that you found along the way as an IBCLC?

[13:39] Rochelle: Resources? Well, there are several things that you can do as far as education. There are several organizations now that offer programs for pathways to becoming an IBCLC. When you do that, you have to buy books and read lots of scientific things. It's not stuff that I had studied as a nurse, really, because it's a little bit different than the regular path of becoming a nurse. It's more specialized. So there are books that are geared toward knowing the composition of milk, how it affects the GI system of an infant, and all of those things. And it's a lot to remember sometimes when you're taking the exam. And there is an exam for an IBCLC, it's given twice a year around the world on the same day. So you can't really cheat if everybody's getting it at the same time. And it is a test that tests your knowledge about the makeup of milk, about the behaviors of infants and young children. It has the whole gamut of knowledge about breastfeeding. And you have to take it every 5-10 years, every five years, I think. I can't never remember. I just know when I have to renew again. And that's coming up in 2025.

[15:22] Michelle: Yeah, I've heard that's quite a process.

[15:25] Rochelle: Yeah, it's several hours of exam. It's kind of like the nursing exam if we all remember that. That was quite extensive too. So it is comparable to that type of exam.

[15:42] Michelle: Well, you and I, a lot of our listeners are, I'll say they're not as old as we are. And when you and I took the boards way back in the day, it was a two-day affair, right?

[15:57] Rochelle: Yes, it was.

[16:01] Michelle: Yeah. I remember being in an auditorium of like 3000 people, and I remember the examiners stood up in front of us and they said, everybody who's here for the second or third time, please stand. And half the stadium stood up and I was like, oh, crap, I'm not going to pass this thing. And of course, I passed it, but it's really daunting when you see the people that were there that were taking the exam many times. So I saw there were quite a few professional organizations related to IBCLCs. And there's the International Board of Lactation Consultant Examiners, there's the International Lactation Consultant Association, the United States Lactation Consultant Association, the National Lactation Consultant Alliance, and then this one I didn't know existed. But I thought it was really cool because the test, to take the test is pretty expensive. And so this is the Monetary Investment for Lactation Consultant Certification. And so I guess they raise money to help people who can't quite pay for the test so that they'll be able to take the exam.

[17:27] Rochelle: I didn't know about that one myself.

[17:30] Michelle: Very cool. Yeah. So we've all had mentors along the way, and I'm sure you've had mentors in your nursing journey, but talk about some of the mentors that you've had in terms of lactation.

[17:48] Rochelle: So the program that I went through was through UC San Diego, and the instructor for that would sign had a list of places you could choose to go to be mentored. I went to Sacramento a couple of times and worked in two different facilities with IBCLCs. In those facilities. I also went to San Diego. That's a large delivery hospital. They deliver about 800 a month and have an extensive NICU. And I worked with that group of lactation consultants. They had six on per day. And one day I got to work with the instructor for the program, which was really amazing.  I'm still friends with her, and I enjoy meeting up with her periodically and just having different models of communication with the different moms, seeing how they can get babies to nurse under difficult circumstances, and working with moms in a NICU scent setting, having those moms pump, and then having their milk given to the babies and how that is a challenge in itself because they don't have a lot of milk to begin with, so they don't think that their milk is important because such small volume. It was multiple lactation consultants that I got to work under.

[19:39] Michelle: Six in a day. Like, we've never known that, right?

[19:47] Rochelle: That is true. But they have quite an extensive staff of lactation consultants.

[19:54] Michelle: Yeah, that's amazing. I wouldn't even know what to do with that many lactation professionals on. That would be very cool. What are some common myths that women have about lactation and breastfeeding that you've encountered?

[20:12] Rochelle: I think the biggest one is, I don't have enough milk. That is huge. They see the baby nursing maybe half an hour after it's already nursed, and they think, well, I must not have any milk because this baby is really hungry. It keeps eating. One of the things that I learned, my instructor was Jinny Baker, and she had a chart that she would draw for moms to see. And one of the things is she'd say, your milk supply is very low and your baby's suck need is very high. And so for the first two to three days, the baby wants to suck a lot. And that stimulation makes your milk supply go up. So don't limit the amount of time the baby gets to be at breast. And if you have pain, get help. And I think the low milk supply is the biggest obstacle for moms thinking that they don't have enough milk.

[21:29] Michelle: So a lot of it is learning baby behavior and how babies behave in the womb and then once they're born. And would you say that many nurses have some of the same misconceptions because they don't really understand baby behavior?

[21:52] Rochelle: Well, it's interesting that you brought up baby behavior, because I took a course from UC Davis strictly on baby behavior, and it was amazing to know that babies don't do random. Everything that a baby does is on purpose, and they are trying to communicate. They can't talk to you, but they are trying to communicate and watching. When the lecturer gave the talk, she had a baby in the front row, I would say was maybe eight or nine months old. And she asked the mother, can I use this baby through my talk? And of course, the mom said, sure. And she was able to predict what the baby was going to do next by the behavior that she was observing in the baby. It was truly Amazing. I would recommend a baby behavior class for anybody who works with babies.

[22:59] Michelle: Yeah. The first thing about figuring out breastfeeding, and lactation is you have to have that as a core. I feel that's fundamental, like, you need to know how babies behave to see how they're going to behave at the breast and to dispel some of those myths about breastfeeding. Being a labor nurse, Rochelle, what are some of the things that we do in labor, some of the interventions, and some of the routine treatments that we do in labor that interfere with breastfeeding, bonding, and lactation, postpartum?

[23:46] Rochelle: So, as you said before, we have to weigh the baby, we have to give the injections, we have to put their ointments. And then we used to, and I think it's gradually changed over time. We used to have to give the baby a bath within 2 hours and transfer it to the mother-baby unit. Hopefully, that has changed.

[24:09] Michelle: It has, thankfully, yeah.

[24:12] Rochelle: Because you should not give the baby a bath. It can set them off in a bad direction, causing respiratory difficulties, and it just is not conducive to bonding and nursing behaviors. And if a baby even has any indication of lasting stress with respiratory distress or anything like that, or temperature, you're going to set them off when you give a bath. That is a huge stress for a baby. And hopefully that's changed.

[24:54] Michelle: But, yeah, I know at Kaweah that's definitely changed. And the person that spearheaded that was our clinical nurse specialist, Linda Ellison. She did a lot of research on the bath and the practice of doing the bath very soon after birth when the baby has not come to any kind of physiological regulation. And we've all seen it right after that first bath on postpartum, the baby gets cold, and stressed, and then the respiratory rate goes up, and the baby turns blue and is coming to the NICU and we've seen it over and over again. And so that was a big project for her. And we don't even aim to do the bath for at least 24 hours after birth. And we really let the family decide after that when they want to do it, because bathing, that's a family activity. And if we're going to be family-centered and provide family-centered care, then that's one of the tasks, I guess, that should be allocated for the family. It shouldn't be that we whisk the baby off and lay them on a cold countertop and give them the fastest bath they've ever had because they're screaming at the top of their lungs. It shouldn't be like that. It should be when the baby has reached physiologic stability, and it should be a pleasurable experience for everybody. So, yes, that's definitely changed. So talk about some of the things that, like a labor patient would get, like pitocin, like an epidural. How do those things affect the baby after it's born and possibly interfere with breastfeeding?

[26:58] Rochelle: Well, there's several things that can affect the baby. An extremely long labor can affect the baby in a negative way. They're just as worn out as mom is. An epidural, even though it's said that an epidural does not interfere and the medications don't get there. If you've had an epidural for any length of time, I guarantee your baby is sleepier than another baby, even though it's not supposed to get into them. Every nurse knows it does. The other thing that can be a negative for the baby is along with the length of labor and the epidural pitocin. I'm not sure that the pitocin itself is the culprit or just what it does to the labor for the mom as causing more stress for baby. You can have interventions that may affect the baby and they may be necessary, but they can all affect the baby in a negative way, making it so that they need more time than another baby to go through the natural process of being able to nurse. And just leaving them alone is really important.

[28:33] Michelle: Yeah, leaving them alone, that's a good message. And we've all seen those babies just hundreds of times, the ones with the epidurals, that they just don't have the same, I don't know, vigor. And they've done studies about the length of time it takes a baby that had, and the mom had an epidural versus a mom that didn't have an epidural to get to the breast. And, yeah, we've seen it in practice, and it'll be interesting to see if that practice slows down or changes in the future.

[29:24] Rochelle: Another thing that I see with moms is the baby has a weight loss above 10%. And I asked the moms, and it's not proven scientifically, and that's unfortunate. I wish they'd do some studies on it, but when the mom has had three or four liters of fluid, and that's before the baby is born, a lot of that fluid goes in the baby, and the first 24 hours, they pee it off and they drop weight big time. And so that's affecting the baby because now it's going to have to have formula because it lost more than 10%. That's a big negative, but it's not proven. There are not any studies on that. So that is just an observational analysis for me.

[30:25] Michelle: And it's so crazy, right? To me, it feels like common sense. If you have a mom that got four liters over her labor period, of course, some of that's going to go to the baby, and then they have this huge drop, and everybody's completely freaking out. The baby has to go to the NICU or the baby has to get started on formula. And that's one of the most distressing things that a parent can hear, is that your baby has lost a great amount of weight. And if you want to make somebody feel like a failure really quick, put them in that situation. Right. And they're scared. And unless they have some education and some knowledge behind it, to know that everything's going to be okay. We might have to do this for a day or two, but not forever. Things would be a lot different. But, yeah, those are a lot of things that we do that interfere. And thankfully, we had some really astute pediatricians and neonatologists that would ask that when we'd have a huge weight loss in a baby. That was one of the first things they would ask is, how much fluid did the mom get in labor? And I thought, all right, we're on to something. You guys need to do a study. We told them that many times because we've seen it.

[31:55] Rochelle: It would be a fairly easy study, I would think, just weigh the output of the baby for 24 hours. Just see how much they actually pee off because they don't have that many wet diapers when they go home and they're just breastfeeding. It's a crazy thing that it would be a pretty easy study, I would think.

[32:24] Michelle: Yeah, I think so, too. How do you educate other healthcare provider writers in the moment when they are practicing with old information, faulty information, or maybe giving the mom information that's not correct? How do you do that? How do you educate your colleagues in the moment?

[32:54] Rochelle: Well, when I was a labor nurse, it was fairly easy because they would ask for help because they realized that I could help get the baby to breast. I think one of the most fun ones was one of the nurses came out and said, I had the baby skin to skin all this time and it's not doing anything. And I said, really? And I went in and the baby was skin to skin, but it was on its back. So it would be very difficult for that baby to flip over by itself. I just thought it was kind of cute because I turned it over and baby did its thing. It may be just something simple just to show, but you kind of have to wait for them to ask. You can't barge in and tell people it's not received very well that way. So hopefully they see by example that what you're doing is important and it works. I think that as I worked in a hospital in Bakersfield for a while, lactation, and I think that was the most rewarding as far as having people watch. The nurses in labor would watch what we were doing and they would start trying to do the same things that we were doing. And I think that's the key, is the person has to want to make a difference for that baby. And mom, if they want to make a difference, they will seek out how to do that.

[34:42] Michelle: Yeah, that's absolutely true. And I think that one of the best ways that we can teach is to teach by example. And I know that you were known for that. I know that students, that nurses would send students in with you because of the way you practiced. And they really were vested in having students learn the right way from the beginning. And the person to do that was you because of the way you practiced, because of the way you cared for the babies, and you understood baby behavior, you understood bonding, and you practiced those things. And I think one of the traits that I saw that I really loved in you is you just had this ability to almost stop time. You just slowed down, and it was amazing to see. It was like there was no rushing around. It was just like, everything's going to get done and it's okay. And this time is so important for you guys. To be together as a family. And just your demeanor, you have this really soft voice and just a really laid back demeanor that I think helped parents, too, kind of relax and leave a lot of the stress behind and a lot of the craziness. So those are some great things that I think it's just great to teach by example, and you've done that your whole career. What would you say is the most difficult part of being a nurse in an IBClC?

[36:31] Rochelle: I would think the most difficult part is having physicians, mainly physicians or pediatricians, that don't understand breastfeeding and don't give it much credit for the health of the baby. I see that still happening. Unfortunately, they do not get a lot of education about breastfeeding in school, and I see that periodically. Still not as much as I used to, but I still hear the stories from the moms that I talk to that the baby is going to have to take formula for some reason, and many times it's not a thing that needs to happen. And I cannot say anything because that isn't my place. I have to try to just support the mom where she is and what's happening to that unit. I think that's probably the most difficult, just seeing that it's slowly changing, but it is a slow change.

[37:53] Michelle: It is a very slow change, and I agree with you. So their lack of education in medical school or if they're a nurse practitioner or whatever their role is, it transfers to their patients. One of the things I would love to see changed is antepartum education for lactation and breastfeeding. We don't routinely have that now. And there are so many opportunities, all those antepartum appointments that the mom has to, at some point during the conversation, talk about right now, your breasts are changing. Here's what your anatomy is doing. Here's what's physiologically happening in your body right now. And we talked about the benefits of breastfeeding, and now you're getting closer. And we want you to focus on skin-to-skin after delivery. All these conversations that could be happening, that aren't happening. And we still have moms that are coming to the hospital that as soon as their babyis out, they're being asked that question, are you going to breastfeed? Are you going to bottle feed? And that needs to go away. I feel like we need to have the assumption that every mom is going to breastfeed until she tells us differently. And we need to practice all the things to support that uninterrupted skin-to-skin teaching baby behavior, all of those things. And I feel like that's the only way that there's going to be big changes. But it does take forever.

[39:50] Rochelle: It really does take forever. Yeah, it's interesting. I talk to moms all over the United States, and it's interesting regionally. So I'll be talking to a mom and I hear a story about something, and I think, well, yeah, I know where you are. And that's the education that's happening there. That's what's happening in that region, in hospitals. And then I'll talk to another mom in a different area, and hear a different story. So it's really interesting regionally, too.

[40:32] Michelle: That's so true. What do you think is the most crucial trait that a nurse needs to have in the IBCLC role?

[40:44] Rochelle: Empathy. To hear their story, to hear what's actually happening to that mom, to hear her wishes, her thoughts, and then support whatever she wants to do. And that's what I try to communicate with them, is I'm here to help you reach your goals, which they're different for every mom. Some moms are very committed to breastfeeding for two years or one year or whatever they want to do, and others are like, I'm trying this. If it doesn't work, it's okay. So you just have to hear what they're saying and try not to be judgmental, because not every mom is the same. I have moms that go, I call them and they'll say, well, I'm formula feeding, and they kind of expect me to give them a lecture. And when I tell them, the most important bond is between you and your baby, and the food is wonderful and it does so many great things, but you are the most important ingredient in raising a baby. So they don't expect me to say that, but I do tell them that it's okay that they can have a healthy baby even though they're not breastfeeding. That's something that needs to be said to these moms. They should not feel guilty if they fail. And I feel very strongly about that, too.

[42:25] Michelle: Yeah, that's a great message. I think so many moms feel guilty about everything that they do as a mom, and it starts out with their choice to breastfeed or not, and talk for a moment about informed consent, because it is a choice to breastfeed. And we hear this a lot. It's a choice. So when the mom says, I want a formula feed, or I don't want to breastfeed, as nurses, a lot of us are like, okay, well, it's her choice, but it's like, well, have you provided any education? Have you found out what does she know about breastfeeding? And I've told this story before that when I was in school for my bachelor's, we had to go out and do community service. And so one of my projects was going out to visit this teen that was pregnant. She was 16 years old, and we talked about breastfeeding. And she said, she just got this horrified look on her face, and she said, oh, no, I'm not going to breastfeed. At that point, I could have said, oh, why not? But what I said was, well, tell me what you know about breastfeeding. And she said, well, she started giggling, and she said, my friend told me that they have to poke holes in your nipples so that the milk can come out. And I said, wow. Yeah, that would scare the heck out of me, too. I wouldn't want to do it, but that's not the truth. And then that was an opportunity for me to talk about her anatomy, that you already have those holes. And she was so relieved, the 16-year-old because she really wanted to, but the information that she had was not the right information. And I think we do that so many times in hospitals where we just don't ask any further questions. She either wants to breastfeed or not. And if she doesn't end a story, how do you think we could start changing that?

[44:45] Rochelle: Well, one of the things you said is antepartum education. I don't understand why every obstetrician's office doesn't have at least some type of program for education about breastfeeding. The moms I work with now, I do not talk to them until many times a week or two after they've delivered. And so by then, it's either working or not working, or they may call me early. They have my information, but they may not call me. And I don't have an opportunity to teach them beforehand unless they call ahead of time. And they can do that. But I rarely get a call about anything about breastfeeding until later. But antepartum is the time to give them the education and knowledge that they need to make an informed decision of what they want to do, whether they want to pump or whether they want to direct breastfeed. There are a lot of people right now who want to pump, and I'm not really sure why. It may be just a lack of knowledge. They're afraid, pain, I really don't know. But there is that, and it's interesting. Every once in a while I have a mom and it'll say, well, I'm going to do this for six months, but when I go back to work, I'm not going to do this anymore. And then I talk to them in six months and they're very committed to continuing. So it's interesting. The whole realm of breastfeeding is interesting.

[46:31] Michelle: So what would you say is one of the favorite things about what you do?

[46:38] Rochelle: Having a mom say, thank you for helping me through this journey. Those words, thank you, are amazing that I can. Every once in a while I'll get a picture because I do work from home and I work on the phone. I don't see these moms. They're all over the place. Every once in a while a mom will send me a picture of a baby. And that is so pleasing to see this little chubby person. And usually, it's about nine months to a year that they send me a picture. This little person that I have been helping get nutrition from mom. Yeah, that's very rewarding. Just having them say thank you.

[47:27] Michelle: Sometimes that's all we need to keep going.

[47:30] Rochelle: Yep.

[47:31] Michelle: So where can an IBCLC work? I mean, obviously in hospitals, but where else can they work?

[47:40] Rochelle: They are needed in WIC, they are needed in the community. You can be an IBCLC and be an independent person helping moms in your community and having your private practice. Every year there's a private practice conference in Philadelphia and you meet with IBCLCs from all over the United States that have their own practices and they do some research, publish books, and all sorts of things. I work for a company that contracts with corporations to provide nursing support through their insurance for moms. I actually had one mom who said she was going to change companies, but the support for breastfeeding was too important, so she wasn't going to do that yet. So I just thought that's pretty amazing that she found that to be of value.

[48:48] Michelle: That's very cool that they are prioritizing that because it's such a short period in our lives and it's kind of like one of those things when you're breastfeeding. It's like, what do they say? Long days, but short years. And the time goes by so fast. And I think things would be so different in our society if we could even meet the goal of one year. I think that would make a huge difference. And I think, like I was saying earlier, I think it's so individualized with moms in what they need and what their situation is, it's all different, what their goals are. My listeners have heard me say this many times, is that I said one of the greatest jobs is being a NICU nurse and a CLC. And I did want to make the distinction between an IBCLC and a CLC. So obviously, you have a much wider scope of practice, much more education, much more rigorous testing, all of Those things. And so as a CLC, we're kind of like a support person. And our course was 40 hours. The test wasn't that rigorous. And we have every three years, we have to renew. But one of the greatest things is being a nurse and knowing all the physiology, the pathophysiology, all the emotional things that the moms are going through, and then also having that lactation education on top of it so that you can help them achieve their goal, whatever it is. A lot of moms who would come into the NICU just wanted to pump while the baby was there. And it's like, okay, well, let's get you pumping and figure out how we're going to do this. Some of them wanted to exclusively breastfeed, but because of the state that the baby was in, maybe the baby was extremely premature or very sick and that had to be delayed. But a lot of those moms went home combo feeding but would call me weeks or months later and say, my baby is exclusively breastfeeding now. And just that feeling that you helped that mom achieve her goals is just everything. Like I said, it keeps you going, right?

[51:38] Rochelle: Yeah. There's one person I remember. She had a baby at 25 weeks gestation. Of course, she could not directly breastfeed, and she went on to breastfeed that baby for two years. And that's just, to me, that is one of the most amazing stories I could ever think of was her and her story. It was truly amazing.

[52:03] Michelle: Yes. Well, we have definitely enjoyed our lactation journeys. And as we get ready to close here, I have just started asking this question, and so you're going to feel on the spot and you don't have to give an answer right away, but is there someone you recommend as a guest on this podcast?

[52:28] Rochelle: Have you had Rita Barron?

[52:30] Michelle: No.

[52:33] Rochelle: I have a lot of respect for her. I really do.

[52:37] Michelle: I think she would have a lot to say.

[52:40] Rochelle: She is pretty amazing and has been in this realm for many years and has helped so many people. So that would be who I think of.

[52:52] Michelle: Okay, well, where can we find you if we want to reach out and talk to you, learn more about you? Where can we find you?

[53:03] Rochelle: Well, I have an email address.

[53:06] Michelle: Okay.

[53:06] Rochelle: That would probably be the easiest, I think you get to me, and my email address is chelrnc@gmail.com, so pretty simple.

[53:22] Michelle: Okay, well, that'll be in your bio. This has been fun, Rochelle. I actually learned things about you that I didn't know, and I thought I knew you really well. So it's been a lesson for me. And I know our listeners have gotten a lot of information, so thank you so much.

[53:44] Rochelle: You're quite welcome. Good luck continuing your podcast because I listened to a few of them and they're always very informative and enjoyable.

[53:56] Michelle: Thank you. I appreciate that. Well, you know, at the end, we do the five-minute snippet, right?

[54:03] Rochelle: Okay.

[54:07] Michelle: It's really fun, I swear. Let me get my timer. And it's fun we get to see the off-duty side of Rochelle. All right, we will start soft tacos or hard tacos.

[54:30] Rochelle: Depends on where they came from. Probably soft. 

[54:37] Michelle: That's true. We're very particular about our tacos.

[54:41] Rochelle: No, you can't get them in Montana. Not good ones.

[54:45] Michelle: There you go. I mean, if you ever want to set up a taco stand, right? You'd probably do pretty well. Okay. Would you rather be able to read minds or predict the future?

[54:57] Rochelle: Read minds.

[54:59] Michelle: I think we're really good at that. Nurses are. I think we do a lot of that anyway. Right?

[55:05] Rochelle: Have to.

[55:08] Michelle: What's something surprising you've learned about yourself?

[55:12] Rochelle: I can tolerate really cold temperatures. It's going to be a high of 29 today.

[55:23] Michelle: You've already had some minus temperatures, too, right?

[55:27] Rochelle: Yeah, a couple of weeks ago. -30 yeah.

[55:30] Michelle: Pretty cool. Jeez, girl, that's crazy. Physical books or ebooks?

[55:37] Rochelle: Physical.

[55:39] Michelle: I still can't get into ebooks. Would you rather never have a wedgie again or never have anything stuck in your teeth again?

[55:51] Rochelle: Oh, that's funny. I think the teeth, because I really don't worry about too many wedgies. 

[56:00] Michelle: I never know what people are going to say. And so I was like, for sure she's going to say, like, stuck in your teeth because you always could floss it out, right? That's so funny. Do you have a life motto?

[56:14] Rochelle: A life motto? I try to love everybody. I guess that's it.

[56:20] Michelle: Well, I think you live that. Okay. Spring or fall?

[56:27] Rochelle: They're both nice, but I think spring.

[56:31] Michelle: Would you rather only ever eat raw food or TV dinners?

[56:38] Rochelle: Raw food.

[56:39] Michelle: Supposed to be the best for you, right?

[56:43] Rochelle: My sister and I had a conversation the other day about vegetables, and my mother used to tell her, you don't like vegetables. And she said I love vegetables. They just can't be cooked. I agree.

[56:56] Michelle: Yeah. And TV dinners can't be very good for you. What's the best advice a mentor ever gave you?

[57:04] Rochelle: That's difficult because I had a lot of different ones. That is really difficult. I guess. Just listen to your patient.

[57:16] Michelle: We could go far just listening. Sunrise or sunset?

[57:22] Rochelle: Sunset.

[57:24] Michelle: Do you have some beautiful ones in Montana?

[57:26] Rochelle: Oh, yes, definitely. Beautiful, blazing colors.

[57:33] Michelle: Okay, last question. Would you rather have one wish granted today or ten wishes granted 20 years from now?

[57:44] Rochelle: 20 years. Let me go that far.

[57:49] Michelle: I was thinking about this one and I was like, yeah, I want one wish granted today. And my wish would be that I'm here 20 years from now.

[57:58] Rochelle: Yeah.

[57:58] Michelle: There you go. This has been fun. See, you passed the five-minute snippet, Rochelle. Thank you. Thank you for indulging me.

[58:11] Rochelle: Yeah. The one thing I didn't talk about was nipples, sizes, shapes. That is such a misunderstood misconception. 

[58:25] Michelle: Yes, I agree. That's a whole other episode for another day.

[58:31] Rochelle: Could we talk about nipples for an hour?

[58:36] Michelle: I bet we could. We've seen it all, right? Probably.

[58:41] Rochelle: I had an incident not that long ago up here with an Amish mom, and the baby was grunting. And I told her her job was to keep that baby skin to skin  And it did fine. But when I got there, they were passing the baby around the room and I was like, no, this isn't going to work.

[59:04] Michelle: Yeah. Seen it happen so many times. Baby grunting, really? Tachypneic. And it's like, well, let's just do a trial, skin-to-skin, and see how this goes. And nine times out of ten, everything's perfect. Very powerful.

[59:22] Rochelle: It is. It's amazing. Truly amazing.

[59:27] Michelle: Well, Rochelle, thanks so much for coming on and giving us so much great information on what you do as an IBClC. I really appreciate it.

[59:36] Rochelle: Hopefully, hopefully, there will be a few more because we need some young ones. So young ones out there, that's what we need, some IBCLCs who are young.

[59:46] Michelle: Yes. That's a good recruiting call.

[59:50] Rochelle: Yeah.

[59:52] Michelle: Well, you have a great rest of your day. Whatever you're going to do.

[59:55] Rochelle: All right, take care. Bye.