It was the summer of 1994 and after a beautiful home birth our third daughter was born. She’s getting married in a few weeks; her white baby clothes from the first days, contrasting so beautifully with her pitch black hair and deep dark brown eyes, are in the attic. In August, they will be replaced by a truly beautiful white wedding dress. Again her eyes and hair, slightly lighter in colour but still beautifully dark, will contrast with her clothes, both with what she will wear during the pre-wedding drinks and with what she will wear during the festive day (that wedding dress) and in the evening, when we are all expected in gala outfit.
On the day of her birth, I could not have imagined that almost thirty years later I would be working as a lactation consultant and medical anthropologist/sociologist. Especially the lactation science is directly connected to her birth. I was literally deathly ill in childbed due to puerperal fever and when we were together in the hospital because of my recovery, I saw that the support for breastfeeding often left a lot to be desired. That is why I became a volunteer at the Dutch breastfeeding association VBN, later a lactation consultant in my own practice, and eventually the trauma-sensitive anthropologist I am today. Some people thought that I was suddenly doing something completely different with that anthropology studies, but I always only saw a straight line from micro to macro to meta level. What happens between mother and child in early life is a template for what follows. What we experience on a small scale in our family of origin becomes on a large scale our frame of reference for how we view the world. And how we all are in the world is the basis of our societies and their associated cultures. Thus, in my experience a direct connection from small to large, from inner to outer environment, from healthy, secure attachment in the parent-child relationship (or lack thereof) to peaceful, empathetic resilience in the world (or lack thereof).

When I was reminded last year that I had to renew my lactation consultant certification this summer (every five years, if we want to keep our ‘IBCLC’ credentials), I did not hesitate: of course I want to remain a lactation consultant! My trauma work as an anthropologist/sociologist within ACE Aware NL and my lactation consultant work for Breastfeeding Center Panta Rhei form such a relevant combination – I want to continue that. In fact… I want to expand it!
So there was no escape: I had to go through the recertification procedure. Since the obligation to take the re-examination has been abolished for re-certifiers (allowed, not required), you must demonstrate in a different way every five years that you have received sufficient training and are also otherwise competent to practice the profession. I consider that justified in itself: mothers and babies are entitled to high-quality care. The only follow-up question then is: how do you demonstrate that you deliver such care? You can provide credits, but have you integrated the knowledge? If, on top of your many years of lactation consultant experience, you have done and learned things other than what the requirements prescribe, does that mean that by definition you cannot provide good care?
With the abolition of the re-examination, the requirements have been adjusted somewhat and thus I had to make the corresponding ‘self-assessment’ for the first time this summer, so that it would become clear in which areas of knowledge I scored sufficiently and where I had fallen behind and should catch up. Nowadays you must also successfully complete a resuscitation course; you must still be able to demonstrate 75 training points (minimum 50 L (‘lactation’) and 5 E (‘ethics’) and a maximum of 20 R (‘related’)), and if necessary, you must be able to provide convincing timesheets. Colleagues said reassuringly that although you have to have everything in order, you will only be asked for ‘evidence’ if chosen for a random survey. I did all the calculations, submitted my recertification application on July 13th and paid off a few hundred euros. A few hours waiting and then the website would report that I can continue for another five years.

The latter was delayed… not a few hours, but days and days. In the meantime I had been away for a week for a retreat in a place associated with my childhood. I needed it and it did me good. However, I kept checking my e-mail and half way through my week I had a message: “Thank you for submitting your application. You have been selected for an audit; we look forward to receiving your documents! Remember: late submission means the end of your certification.”
Ai, ai, ai… the lack of a quick confirmation had already made me suspect this… and also made me fear this to some extent. Now I had to collect a lot of attachments and prove that I really am still worthy of that credential.
Self-assessment: check. CPR course: check. Training points: check, big check – more training than I thought! But that one part, that time registration… I dreaded that. My rough estimate beforehand now needed more detail. A very busy master year for my studies, a year of board work with limited time for consultations, for all kinds of reasons re-energising after that board year, focus shifted to more biopsychosocial aspects of early childhood… would I get the required number of lactation hours?
In my mind, I went back to all my activities in the preceding five years. I realised that, in addition to the consultations, I had worked hard on the thorough revision of the professional profile. I had also made a solidly substantiated version of it, translated into English, for the European lactation consultant organisation. In addition, I had written an evidence-based essay in response to a draft guideline on the parent-child relationship and the role of breastfeeding and secure attachment therein. I had made the Dutch translation of James McKenna’s second, thick book and had gotten it published by a major Dutch publisher. I had followed all kinds of trainings and courses for ACE Aware NL and read endless books and articles that gave me more and more insight into why it is often so difficult for mothers during the early postpartum period, why their births do not always go smoothly, and how they then struggle with breastfeeding problems. However, none of these things had earned me CERPs, the educational points accredited by the international lactation consultants certifying body. Now that I had to demonstrate both my hours and my CERPs, I became aware that the frame of reference is actually rather narrow. That R category… I was only allowed to record 20 points in that category, while much of what makes me a much better lactation consultant now than before falls exactly in that category or in none at all.

Working out my hours and my CERPs, placing them in exactly the right row… it made me a bit rebellious, but mostly sad. Once again I realised how far we are from a trauma-sensitive approach, from a holistic rather than a fragmented, reductionist approach to health problems. A mother and a baby who together cannot get the breastfeeding relationship going smoothly… there is almost always much more going on than ‘just’ a lactation-related, ‘technical’ bottleneck. Of course, latch should be observed and corrected if need be; of course, anatomical or neurological problems in the baby must be ruled out. And naturally you have to look at how pre-existing medical problems have a place within the breastfeeding relationship, but… from a trauma-sensitive approach you know that even all these things may (and very often probably do) have much deeper roots.
There is still a lot of hesitancy to include these trauma aspects. And there is often a lot of fear to talk about them with clients: can they handle it, do they want to talk about it, is it not rude to discuss them? In such cases, it is good to remember that when such questions come up, they are often a mirror for your own pain, for your own triggers and your own survival strategies. When you develop the competencies that are necessary to enter into that vulnerable, intensely personal conversation with the client in a safe, constructive, compassionate way, a wonderfully beautiful depth arises in the consultations. Then a moving connection arises, because the client feels the safety to restore the connection with their deepest Self. What an honour to be allowed to be present and to contribute to it… talking about high-quality care!
Elsewhere in Europe it took them a few days to study all my attachments, but it all worked out: last Monday I received the message that I am recertified until December 2028 – hurray!
Free rein, therefore, to further the development of trauma-sensitive lactation consultations!











