Only moments after giving birth to my daughter, Sunday, two years ago, I distinctly remember my OB nurse looking at me, saying, “Okay, are you ready to breastfeed?”
I wasn’t — and I had no idea what I was doing but, much to my surprise, the baby latched and we were off.
The health benefits of breastfeeding — which the World Health Organization (WHO) suggests new moms do exclusively for six months — are well-documented: Breastmilk can help protect infants from getting sick and lower the risk of issues such as asthma, obesity, and sudden infant death syndrome (SIDS), according to research. The act helps you heal postpartum (in those early days, your uterus literally contracts when your baby latches, helping it to return to the size it was pre-baby), and it even lowers the risk of issues such as type 2 diabetes and certain types of cancer for mom in the future. Plus, it’s eco-friendly: no plastic bottles, production or transport waste, etc.
As a mom, I feel lucky: My breastfeeding journey lasted about a year and had few snags. But as the founder of Dear Sunday, an online platform for new and expecting moms, I regularly have moms tell me how shocked they are by the experience.
After all, just because breastfeeding is natural doesn’t mean it always comes naturally. Plus, it’s time-consuming (did you know new babies can eat upwards of 12 times a day?!) and — if issues arise — stressful. (Research by the UC Davis Children’s Hospital found that 92 percent of new mothers had at least one breastfeeding problem within three days of delivery.) I’m also a big believer in feeding your baby in the best way that works for you and your family — and the fact is, not all women are able to breastfeed. (See: This Woman’s Heartbreaking Confession About Breastfeeding Is So Real)
Experts suggest thinking about breastfeeding as an art — something that needs to be learned and practiced. And fortunately, there’s a whole category of professionals called lactation consultants who help pregnant people and new mothers do just that.
If you decide to? Here’s what you need to know about lactation consultants, what they do, and how to go about hiring one during or after your pregnancy.
What does a lactation consultant do?
In short, lactation consultants share one common goal: support women who choose to breastfeed, says Emily Silver, M.S., N.P.-C., I.B.C.L.C., a family nurse practitioner, lactation consultant, and co-founder of Boston NAPS. “Lactation consultants help women establish a deep latch so they don’t have pain with feeding; curate feeding plans for women who are breastfeeding and supplementing; size women and educate them on pumping; and help women navigate specific troubles, pains, or infections.”
A lactation professional should be able to distinguish between functional and dysfunctional feeding, adds Sharon Arnold-Haier, IBCLC, a New York-based lactation consultant listed on the maternal wellness listing service Robyn. “Most lactation consultations will involve breast assessment, infant oral assessment, and observation of a feeding. Some lactation issues will be simple and others will be complex, requiring ongoing care.”
Often, a lactation specialist can provide more than just lactation support, notes Silver. “We can provide emotional support and screening and referring for postpartum depression,” she says. “Often, our visits encompass parenting survival tips and how to work together as a team to get into good routines on things like healthy sleep habits. We aim to get to know our patients on a personal level to help them make the best choices for them and their family as a whole when it comes to feeding.”
And while it’s super important for a lactation consultant to work within the scope of their practice, some practitioners are lactation consultants and nurse practitioners, M.D.s, or other types of healthcare providers, which means they might be able to write prescriptions and treat more complex cases, says Allyson Murphy, IBCLC., a New Jersey-based lactation consultant.
How has this changed during COVID-19?
While some home visits are still happening with proper personal protective equipment (PPE) and screenings in place, there’s also a much larger presence and need for virtual visits and calls with lactation professionals. “We have almost tripled our rate of virtual visits and phone support during the pandemic to provide care to those who might have risk factors for COVID, vulnerable people who cannot have a provider come in, or those who live somewhere that does not have a ton of lactation support,” says Silver. (Related: Moms Share What It’s Like to Give Birth During COVID-19)
Virtual visits — especially in the first few days you’re home — can be hugely helpful. “Many clients feel a virtual visit will not be beneficial, but I find virtual visits to be very successful for most families,” says Arnold-Haier.
What should you look for in a lactation consultant?
Generally speaking, there are two main types of certified lactation consultants — International Board Certified Lactation Consultants (IBCLCs) and Certified Lactation Consultants (CLCs). IBCLCs must complete 90 hours of lactation education and clinical experience working with families. They must also be recognized as health professionals (such as a physician, nurse, dietitian, midwife, etc.) or complete 14 health science courses before sitting for an exam. CLCs, on the other hand, complete 45 hours of education before passing a test but are not required to have previous clinical experience working with patients before certification.
Certification distinctions aside, you want to pick someone who’s on the same page as you and in line with your beliefs, notes Silver. Perhaps this means a lactation consultant who can think outside of the box. “Just like a pediatrician, this is someone you get close with and want to be able to turn to for help and support in a non-judgmental way,” she says. “There are a lot of ways to feed a baby, including exclusively breastfeeding, breastfeeding and using bottles, pumping and using breastmilk, or even breastfeeding and using some formula. It’s about identifying the best plan for you.” If you feel like breastfeeding isn’t working, an IBCLC can help you troubleshoot and find the best solution for your family. (Related: Shawn Johnson Got Real About ‘Mom Guilt’ After Deciding Not to Breastfeed)
You also want someone who is going to treat you with kindness and empathy, says Murphy. “By the time someone reaches out to me, they are often feeling like they’re in crisis mode: they’ve Googled, texted all their friends, and they’re panicking, on top of being exhausted and hormonal.”
Are lactation consulting services covered by insurance?
FWIW, lactation services are considered preventative care as part of the Affordable Care Act (ACA), which means that they should be covered. But, go figure: “The way each insurance provider interprets the law varies greatly, which means that some lucky people get six postpartum visits covered at no cost and the unlucky among us are stuck paying out-of-pocket and seeking reimbursement after, which may or may not happen,” says Murphy.
Your best course of action: Check with your insurance company before you see a lactation consultant so you’re clear on what’s covered. One other tip? “You will likely do better with a reimbursement if your lactation consultant is also a licensed health professional such as a physician, nurse practitioner, registered nurse, physician’s assistant, or, in my case, registered dietitian,” explains Arnold-Haier.
If you have to pay, how much will a visit cost?
If you can’t have your lactation consultant’s services covered through insurance, the cost of hiring one will vary depending on where you live and how much experience the consultant you’re considering has. But the experts interviewed for this piece estimate an initial visit to cost anywhere from $75 to $450, with follow-up appointments being shorter and likely cheaper.
“I recommend speaking with the lactation professional prior to scheduling a visit to find out how they run their practice and what you can expect for their fee,” suggests Arnold-Haier. It could range from a single one- to two-hour visit to a written care plan, or even follow-up communication. The number of times you see meet (virtually or IRL) with your consultant will totally depend on how much support you’d like.
When should you consider hiring a lactation consultant?
First, let’s clear up a big myth: you don’t only need a lactation consultant when something is wrong. “I always say, don’t wait until something is wrong or until you are in a bad place to check in with a lactation consultant,” says Silver. (Related: Should You Hire a Doula to Help You with Pregnancy and Childbirth?)
“I am a huge believer in prenatal lactation classes. I teach them, I love them, I see them work,” says Murphy. “Breastfeeding is a new skill that must be learned. Going into it knowing what’s normal and what’s not helps you feel more confident, helps you spot bumps in the road ahead before they become a full-on crash, and lets you establish a relationship with an IBCLC before you deliver.”
It’s also worth noting that, generally speaking, at a hospital or birthing center, you will have the opportunity to connect with a lactation consultant. COVID has, unfortunately, made this less likely. Arnold-Haier, who works both in a hospital setting and privately, says that in the midst of the pandemic, new parents and infants are being discharged faster than usual. “As a result, many are not able to meet with a lactation consultant before going home and infant feeding can look very different from day one to day five and onward, so quick discharges are leaving many without the support they deserve.” (On a similar note: The Rate of Pregnancy-Related Deaths In the U.S. Is Shockingly High)
Once your milk comes in (usually once you’ve already been discharged), there’s a chance you’ll experience engorgement. And engorgement can lead to trouble latching and potentially a change in how you position yourself because of your milk coming in, says Silver. “It’s a time of an abundance of questions and it’s a way for us to assess mothers post-delivery: How are you doing? How are you feeling?”
If you’re not considering hiring a lactation consultant before attempting to breastfeed? Do be sure to reach out to someone as soon as an issue arises. “Unaddressed issues can sometimes compound into bigger ones like clogged milk ducts, mastitis, slow weight gain in baby, or milk supply issues,” says Murphy. “Support groups run by an IBCLC or trained volunteers like La Leche League or Breastfeeding USA can also be a great place to start for reliable, evidence-based info.” Sometimes, you can get answers to simple questions without booking to see someone.