Do I need a lactation consultant? When it’s a yes

When do I need a lactation consultant - mom and baby

There is never a wrong time for a lactation consult. Lactation consultants not only deal with a current issue, but can help prepare you for what to expect in the coming weeks and days. Here’s how to tell if you need one, who’s at high risk for lactation issues, and so many other details you should know.

How do I know if I need a lactation consultant?

If you are even contemplating whether or not you may need help, just call or email. I would rather a parent call with minor issues right away rather than continue struggling for days or weeks. Then, by the time I hear from parents, we are dealing with major issues that could have been caught earlier. The deadline I give my clients is 2 weeks. If you have reached 2 weeks postpartum and have not seen significant improvement in breastfeeding, reach out to an IBCLC. Also, contact an IBCLC if you’re at high risk for lactation issues.

When’s the best time to find a lactation consultant?

It depends on your situation. If you have had issues previously and it was never determined why the issues occurred, I would recommend seeing an International Board Certified Lactation Consultant (IBCLC) prenatally to set up a plan before delivery. If you have specific risk factors for low milk supply or delay in onset of milk production, it can help to meet with an IBCLC prenatally to prepare yourself.

But for anyone, it doesn’t hurt to find a lactation consultant prenatally. It is probably one of the last things you want to think about researching in the midst of a problem. Having someone lined up prior to delivery can save you a lot of time later.

Who’s at high risk for lactation issues?

Anyone who is at high risk for lactation issues should reach out prior to delivery or right after. Some factors for high risk are:

  • had a long/rough delivery
  • gestational diabetes
  • polycystic ovarian syndrome (PCOS)
  • issues with infertility
  • no breast changes during pregnancy or puberty
  • asymmetric, odd-shaped, or wide-spaced breasts
  • previous issues with low milk supply, latch, or breastfeeding
  • first time parent
  • family history of tongue or lip ties
  • infant weight loss >10%
  • milk increase not noticed by 3–5 days postpartum
  • infant still not latching or latching well by discharge from the hospital
  • pumping or supplementation by hospital discharge
  • infant is not taking both breasts easily within the first few days

In these situations, follow up with an IBCLC within 1–4 days of discharge from the hospital.

Will it be embarrassing working with a lactation consultant?

I do not find consults to be awkward or embarrassing. But I do see breasts all the time: all shapes, sizes, colors. I have seen it all. I understand for many parents this experience can be uncomfortable at first because we all have things about our bodies that we are not comfortable showing others. The whole experience can feel intimate for that reason and postpartum leaves us feeling especially vulnerable. A good lactation consultant will fully acknowledge that and keep an open line of communication at all times while respecting your needs.

A lactation consult respects your boundaries

You should be assured that everything is very professional during a consultation. Seeing a lactation consultant is just as professional as seeing your OB or primary care doctor. The consult also occurs in the comfort of your own home, so I find many parents are more relaxed because they are in their own environment. I do not touch you or your baby without your consent. I actually prefer to remain more hands off because I want you to learn the skills we are working on. That way, you get comfortable with them before I leave you. If I do need to physically assess your breasts or your baby, I am very clear about what exactly I am assessing for and why it is important.

Sharing your health history

Be completely honest with your lactation consultant about your body, health history, and experiences. Many things connect to lactation that people are not aware of. Some questions may seem unrelated but we can help you understand their necessity.

I also perform a mental health screen for postpartum depression (PPD) at my consults. In the U.S., you see your pediatrician a few days after birth and then not until 2 months. You see your OB at 4–6 weeks postpartum. Such a long gap in between means depression may not be recognized early. Breastfeeding difficulties can contribute to feelings of depression or exacerbate feelings already be present. While not every lactation consultant performs this assessment, I believe in holistic care and treating the whole person, not just the body part or symptom.

Should my partner be with me for the lactation consult?

It is absolutely helpful to have your partner present! The more people who hear and see the interventions that can help, the better. Your partner is the one who will be there at 2 a.m. when you are exhausted and with you throughout this experience. Research shows parents who have support from their partners they are more likely to succeed with their goals. I love for partners to get involved, so they know exactly how to best support you during this experience.

Do lactation consultants take insurance?

All insurance companies and plans are different. But when the Affordable Care Act went through, it mandated insurance companies to cover lactation consults. What or how much they cover can vary. The best way to find out if you have coverage is to call your insurance company and ask what exactly they cover.

If a lactation consultant is part of a hospital network or physician office, it is possible that the group will bill insurance directly. Some private practice lactation consultants bill insurance companies for you, if it is an insurance company they are in network with. Many private practice consultants will charge a fee for a service but give a super-bill after the appointment. You usually can submit this to your insurance company for reimbursement. For more answers, take a look at this resource from the National Women’s Law Center about insurance coverage for lactation services.

What do you wish you could tell new moms about breastfeeding that they don’t know to ask?

Don’t give up on your worst day and set realistic expectations. Many parents think it’s not important or the time to learn about breastfeeding prior to delivering their baby. Later, they realize it would’ve been helpful. Trying to learn about breastfeeding after delivery is hard when you’re recovering from birth, in pain, and sleep-deprived.

Breastfeeding requires learning from parents and your baby

Breastfeeding involves many new skills and knowledge. It is absolutely something to prepare for prior to delivery. Breastfeeding is not natural and effortless like it’s made out to be. It needs to be learned by parents and the baby. Breastfeeding takes processing new information and time to get good at it for both of you. Having this understanding helps you set realistic expectations about what breastfeeding will look like.

The breastfeeding learning curve lasts longer than you might think

Many parents report that breastfeeding didn’t seem easier until about 4 to 6 weeks postpartum. Around 2–3 months, they really felt breastfeeding seemed “natural.” If this is your first breastfeeding experience, I recommend setting short-term achievable goals. Set a goal for 2 weeks or one month to gauge your comfort level. When you reach that goal, reevaluate and set a new goal.

How breastfeeding goes early on isn’t how it will always be

When breastfeeding gets difficult, it is really hard to imagine doing it for an entire year. With that being said, what many parents experience in the early weeks is not an indicator of what breastfeeding will look like long term. Don’t think it will always take as much time and practice as it does in the early weeks. It gets easier. Research actually shows that too. Once babies get good at breastfeeding and parents get more comfortable (after about 4–6 weeks), breastfeeding takes less time than other feeding options.

Ask for help before you quit on your feeding plans

If you are on the verge of stopping, ask for help. Early intervention makes many issues fixable. If you are rundown, make sure your needs are met. Have you slept recently? Eaten? Are you drinking enough water? Have you taken some time to yourself? If the answer is “no” to any of those, do those things first before making a final decision. Hunger, thirst, and sleep deprivation guide rash decisions.

There also may be alternative methods of feeding you did not realize are an option. Choose in-person or a telehealth lactation consult, but reach out to someone who is skilled in breastfeeding support to help you work through your options. Breastfeeding is never all or nothing. Social media and online forums become great resources. But more often than not, I see people giving really bad (even harmful) breastfeeding advice in these places. Well intentioned, yes. What works for one family does not work for all families. You need someone who knows your history, understands your goals, and gives you options that fit you and your family.

Join a support group that’s monitored by an accredited professional

Many support organizations use social media to reach parents, which is great. I advise joining one of these groups on social media but make sure it’s monitored by an accredited professional with the knowledge and experience to help you. These professionals will rely on evidence-based information to answer your questions. You want a group that is well moderated by a person or people trained in lactation and counseling.

Jennifer Abdul-Rahman, BSN, RN, IBCLC
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