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Whether you’re a soon-to-be mom, have just welcomed your baby or are already well established in new motherhood, breastfeeding is probably something that’s on your mind—like a lot. While there is more than one way to feed a new baby, breastfeeding is the most popular starting off. In fact, of the estimated 4 million babies born in the year 2015, 83.2 percent of them started out on the breast, per research from the Centers for Disease Control and Prevention (CDC). That’s quite impressive—but it’s often met with much difficulty for both mom and baby.
That’s where a lactation consultant can come in clutch—helping to foster a healthy feeding bond between mother and baby. This type of health care worker is actually trained and certified as an IBCLC (International Board Certified Lactation Consultant), CBC (Certified Breastfeeding Counselor) or CLC a (Certified Lactation Counselor) and understands the entire breastfeeding process, including how milk is produced, the composition of milk, the anatomy of the breast, proper latching, positions for breastfeeding, hand expression, pumping, proper milk storage and alternative feeding methods, explains Christy Abrams, R.N., labor and delivery nurse certified in perinatal mental health as well as childbirth education.
People who have medical or surgical issues such as breast reduction surgery or infant prematurity can also greatly benefit from a lactation consultant, notes Kameelah Phillips, M.D., an OB/GYN in New York City.
Even if you’re not sure you want to breastfeed—or breastfeed for that long—a lactation consultant can be an incredibly useful tool in your box to ensure that the process goes along smoothly. “Having a skilled lactation consultant in your corner will make overcoming breastfeeding challenges easier,” says Yines Garcia-Taylor, B.S.N., R.N., I.B.C.L.C., a nurse, lactation consultant and founder of Prenatal Yini. “Breastfeeding is not one size fits all, so personalized care to address lactation-related questions and concerns can provide the peace of mind and guidance each unique family needs and deserves.”
If you’re considering using a lactation consultant, there are a few important questions you should ask them prior to working with them.
A Certified Lactation Counselor (CLC) is a lower credential than IBCLC, appropriate for helping breastfeeding parents with simple problems. To obtain the CLC credential, a candidate only has to take a 4.5-day course and a test. The coursework is important, but it’s only “book learning,” and it only covers less than one week of material. They are not required to have graduated from high school or have any clinical experience with breastfeeding families. Their 2014-2015 training manual specifically states that, “CLCs are Certified Lactation Counselors, not ‘Consultants.’ ” The credential expires after three years and requires only 18 continuing education hours for renewal. CLCs are never required to retake the test.
In contrast, the IBCLC certification requires several university-level health science and human lactation courses and hundreds of supervised clinical experience hours before being allowed to take a rigorous, high-level board exam similar to the level of exam required to become a registered nurse (RN). To ensure that their knowledge remains up-to-date, IBCLCs must recertify every five years with proof of 75 hours of continuing education (70 hours in lactation and 5 in ethics) and retake the exam every ten years. With this high credentialing standard, an IBCLC is qualified to address all levels of breastfeeding problems and challenges from simple to complex.
Considering the fact that you’ll be working with your lactation consultant in a very intimate way, it can be helpful to meet them beforehand to connect, build rapport, discuss health history, what to expect during birth and postpartum and to develop a breastfeeding plan to meet feeding goals before the baby arrives, explains Garcia-Taylor. “A prenatal consultation will also cover breastfeeding basics information,” she adds.
Especially in the age of COVID, it’s important to know under what circumstances your meetings with your lactation consultant will take place. Virtual visits may provide moms the safety and flexibility they’re looking for, notes Garcia-Taylor. “For example, if a mom is having a latching issue she may prefer an in-person consultation, whereas a mom who is exclusively breast pumping may opt for a virtual consultation,” she says.
“Breastfeeding looks different for every family, so it’s always a good idea to know when to reach out to a lactation consultant,” says Garcia-Taylor. She recommends looking at these conditions as anticipatory guidance. “Discussing conditions will help moms identify when to look for additional support from a lactation consultant,” she says.
Under the Affordable Care Act (ACA), most insurance companies will cover up to six lactation consultations—and one of these can be a prenatal consultation. “Many IBCLCs are in-network or work with medical insurances while others will provide a superbill (receipt) for you to submit to your medical insurance for possible reimbursement,” says Garcia-Taylor. She recommends contacting your medical insurance during pregnancy to confirm whether or not they provide lactation coverage.
Knowing what you need to come with, such as filled-out forms, breastfeeding supplies and when you should last feed your baby prior to your appointment, can help save you time and feel more prepared as you arrive for your consultation. And the only way you’ll know what to bring is if you ask. Garcia-Taylor recommends also making a list of questions and having breast pump parts clean and ready if pumping will be covered during the lactation consultation. “Also, make arrangements beforehand to limit distractions (pets, older children) during your consult will allow the time spent to be more productive.”
This is the question nearly all new moms ask their lactation consultant—and it’s an important one, since you obviously want to make sure your little one is getting all the nutrients they need. “A baby that is gaining more slowly than average or falling off their growth curve is a cause for concern and lactation consultants can suggest ways to improve supply,” says Mindy Cockeram, LCCE CLEC, a Certified Lamaze Childbirth Educator. “Lactation consultants also record the baby’s weight before and after a feed to assess how much they are taking in, make recommendations regarding latch and positioning and can also discuss possible galactagogues (foods that increase supply).”
This is a common and helpful question for new moms to ask a lactation consultant. “Asking this question opens the door to a discussion around infant feeding clues so you can understand and look out for when your baby is hungry,” says Dr. Phillips. “It also allows you to learn about how often and variable infants eat.”
Breastfeeding is often painful at the start, but it shouldn’t be once you get going—often past the first two weeks. In fact, if the mother is in pain, Cockeram warns that the latch is often too shallow, and if the baby’s suck is weak, it’s often that their tongue is restricted or the nipple is damaged. “Often different positions can solve the pain problem and lactation consultants are experts at improving the latch,” she says. “Once the lactation consultant knows that you are in pain, she will offer guidance as to how best to improve it.”
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