Telehealth lactation consult? An IBCLC shares details

Telehealth lactation consult mother and baby
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Lactation consults feel personal—and like they need to be. So do telehealth lactation consults really work? (The answer’s yes!) Here’s everything you need to know, from what issues lactation consultants help with virtually and how, what to expect during a telehealth lactation consult, and what to look for in a consultant.

What issues can a lactation consultant help with in a telehealth lactation consult?

In-person or virtually, lactation consultants support you along the entire continuum of breast/chest feeding, from infancy through toddlerhood through extended breastfeeding. However the visit occurs, we can help with initiation and cessation of breastfeeding, including cessation of lactation after a miscarriage or infant loss. During lactation consults, we also assess for oral restrictions or structural issues of the body.

It’s helpful if your lactation consultant regularly works with other specialists who help get babies through breastfeeding difficulties. As needed, I communicate with dentists and ENTs, pediatricians, chiropractors, family providers, physical therapists, speech therapists, etcetera. IBCLCs do not diagnose “tongue ties,” but we do diagnose breastfeeding issues. Similarly, we do not diagnose torticollis or muscular issues. However, we can assess for the tightness that is seen in babies and the functional issues it causes at the breast.

I often implement interventions to make breastfeeding work until clients follow up with referrals to appropriate providers. Lactation consultants provide assessments that assist providers in making a medical diagnosis. Then, we help come to a treatment plan based on that diagnosis. Having a lactation consultant that works collaboratively as a team is important. Each healthcare provider plays a vital role in the process.

Are lactation consultations available during COVID-19?

First and foremost, I want to reassure you that there are resources available during coronavirus. Not everything may be in person or face-to-face. Some lactation consults will be via telehealth. But that doesn’t mean help is not out there. We know a lot more now then we did a few months ago, especially about the benefits of breastfeeding if you contract COVID-19 and how to do so safely.

What will a COVID-19 home lactation consult look like?

Both peer-to-peer support organizations around the world and lactation consultants have been working diligently over the last few months to expand their services to include telehealth lactation consults. Many of us already offered telehealth prior to COVID. But since COVID-19 started, educational opportunities for how to best serve clients in a remote visit has really improved.

In my area, once we entered the green phase, I restarted home visits with precautions. I wear a mask the entire time and prescreen questions prior to our appointment, such as:

  • have you had a fever >100 degrees Fahrenheit in the past 72 hours
  • have you experienced shaking/chills
  • do you have an unexplained cough, loss of smell/taste, new onset cough, difficulty breathing, sore throat, unexplained muscle aches
  • have you had a diagnosis of COVID in the last 14 days
  • are you living with someone who has been diagnosed with COVID in the last 14 days
  • have you had unprotected contact with anyone who has been diagnosed with COVID in the last 14 days

What precautions are taken in a home lactation consult during COVID-19?

If you pass the screening assessment, we can continue with the home visit. As a registered nurse (RN), I am well trained on infection prevention protocols. Even prior to COVID-19, your consultant should’ve always washed hands right when entering a client’s home. I also always remove my shoes. (We traditionally do not wear shoes in our house, so I feel weird doing it in other peoples homes!)

Since COVID-19, I have taken additional steps when in-home visits are needed. Your consultant should frequently wash hands or use hand sanitizer throughout a consult, remove shoes or wear booties, wear a mask, wipe down scales with a medical-grade alcohol-based wipe, and sanitize all equipment in between appointments. I wear gloves during a consultation if I am touching you or your baby, including when doing an oral exam on your baby. During COVID-19, I try to minimize close contact as much as possible.

The number of cases your state is seeing and the phase your state is currently in may dictate how lactation consultants are handling home visits. It doesn’t hurt to reach out and ask if they are still doing them. It also depends on the lactation consultant’s comfortability level and risk factors with home visits during COVID. In most instances, telehealth visits can be just as effective as in-person consults.

If you don’t pass the assessment or if you prefer, we switch to a telehealth lactation consult. I also offer telehealth lactation consults for those who live outside my travel radius. All lactation consultants who do this need to use HIPAA-compliant platforms for video, messaging, and email, so your personal information stays protected.

Can a lactation consult really be done effectively virtually?

Yes! During a virtual consult, all the same assessments are provided (minus the weight check). For a telehealth lactation consult, two people really need to be available. Talk with your partner, friend, or family member beforehand and decide jobs. One needs to perform the manual assessment. The other holds the camera over the baby as the assessment is happening. With the help of props and verbally, I walk clients through how to perform some of the manual parts of the assessment and view your baby’s response through the camera.

What can I expect a telehealth lactation consult to look like?

For a great telehealth lactation consult, expect to see a lot of pictures and demonstration items, like crocheted breasts. These help you know exactly how to do the assessments, positioning, and what latch looks like. Virtual consults make for some limitations when checking oral function. However, they can be overcome. For example, I have multiple symptom-based tools I use to determine function of the tongue virtually.

When lactation consultants are experienced and work from a place of guiding parents rather than doing it for them, telehealth visits are effective and efficient.

Many hospitals have switched their education to a virtual platform and hospitals along with peer to peer breastfeeding support organizations have switched to virtual support meetings as well! It may not be exactly the same as being face to face with other parents but it does give you the opportunity to have questions answered, receive the support you need, and talk to other parents who are experiencing the same things you are.

What should I look for in a consultant, whether for an in-person or telehealth visit?

When looking for breastfeeding advice, ask yourself these questions:

  • What experience does this person have?
  • How many families has this person helped?
  • What are their credentials?
  • What type of training do they have?
  • Does this person complete continuing education regularly?
  • Is the education they give evidence-based?
  • Are they associated with a reputable organization?
  • Is she familiar with virtual visits? (For telehealth lactation consults)
  • Are they giving me advice or support?

All of these factors are important. One that gets clients thinking is the point on advice versus support. Remember advice is: Hey, this is what worked for me. You should try it; it is really amazing!” Support is: Wow. It seems like you are having a really difficult time. What can I do to help you?” Knowing the difference can help you decipher who and which options may be most beneficial for you.

Jennifer Abdul-Rahman, BSN, RN, IBCLC
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