Lactation Consultant

Sarah Quigley, IBCLC, lactation consultant

A lactation consultant (LC) is an invaluable resource for you and your baby — an expert in all things baby-feeding-related. And these consultants are more accessible than you might think: All insurance companies should cover lactation services at 100 percent, as mandated by the Affordable Care Act. Not sure if you’re covered? It’s always best to discuss coverage with your insurance provider first. If you run into problems, the National Women’s Law Center has a great, free toolkit to help you maximize coverage of lactation care coverage.

What is a lactation consultant, and why would I want to hire one? Don’t most hospitals provide one?

A lactation consultant (LC) is an expert in all things related to feeding your baby. They can be helpful no matter how you’re planning on doing it — breastfeeding, pumping, formula feeding, supplementing, you name it.

While feeding your baby seems like it should be relatively easy, like many things on this journey, things don’t always go as planned. The first few weeks are usually the most challenging — LC’s can help show you the ropes, answer your questions, give you tips, and be a resource until you get into the groove.

They can also educate you on (and ease) breastfeeding challenges and transitions: nipple pain, baby’s positioning while feeding, formula supplementation, low milk supply/oversupply, tongue/lip-ties in baby (they’ll refer you to a pediatrician, dentist, craniosacral therapist or ENT when appropriate), plugged ducts and/or mastitis, introducing a bottle, pumping, transitions like going back to work, and weaning. 

All hospitals offer inpatient lactation care after delivery, as well as outpatient clinic appointments. Our advice is to make the most of the resources provided every step of the way. Most postpartum nurses, for example, have some training in breastfeeding and may be helpful in providing advice related to basic early lactation challenges. We encourage parents to ask their nurses for lots of help throughout their hospital stay. This can feel more empowering than waiting for the lactation consultant to show up, which sometimes happens in the middle of the night or 15 minutes before discharge. Being proactive might also motivate your nurse to call in a lactation consultant early, when the obvious solutions are not working.

For most people, the hospital stay is a whirlwind of emotions, huge hormonal shifts, exams, and family visits, layered on top of exhaustion after you’ve just embarked on the most physically and mentally challenging experience of your life. For that reason, we think it’s a great idea to set up an appointment with a lactation consultant in the early days and weeks postpartum. If you select a lactation consultant to work with prior to the birth of your child, all you or your partner will need to do is make a quick call or text to set up an appointment once baby arrives. 

What does a typical session look like? 

Every session is different, and it often depends  on where you’re seeing the LC. You can see a consultant in the hospital (all hospitals offer inpatient lactation care right after delivery, as well as outpatient clinic appointments), in your OB/GYN’s office, at the pediatrician, or in your home.

In your home, a lactation consultant can evaluate what’s going on with you, your partner, and your baby, in context. In most cases, they’ll actually spend a few hours with you to discuss how you’re feeling, your questions, concerns, and expectations for the coming days and weeks. Private home visit LCs bring a pediatric scale and may also have some basic breastfeeding supplies on hand. They typically write up a summary of the visit to share with you and provide follow-up communication by phone or email for a week or two after the session.

If you see the LC in a hospital/doctor’s office setting, the appointments are traditionally 60 to 90 minutes, with more time for twins. It’s ideal to schedule your appointment at a time when baby is just about to eat so that your LC can look at baby’s latch and watch while you’re feeding them. We loved having our partner or a close friend there during our sessions to help take in all the information. 

Visits can also look different depending on whether you see the LC in the early days or when you’re further along in your relationship. And, of course, the exact makeup of your appointment depends on you and your baby’s individual situation. 

In the early days you might discuss the emotional and hormonal shifts that come along with having a new baby, latch issues, and feeding schedules. Later, conversations might be more focused on returning to work or weaning. You can recruit an LC’s help at any point in your specific journey. 

When should I schedule an appointment?

You can make an appointment while pregnant to prepare for feeding your baby or wait until after baby comes. You could also take a class on feeding basics and then decide how to proceed.

Visiting an LC while pregnant can be especially helpful for first-time mamas, mamas who have experienced low milk supply or breastfeeding challenges with previous babies, and those who have anatomical or structural breast concerns or potential risk factors for breastfeeding difficulties (breast surgery, etc.). A prenatal lactation session can also serve as a mini-breastfeeding class, and partners and support people are encouraged to join.

During these sessions, you’ll learn how to optimize the first few days to establish breastfeeding and what to expect to feel better prepared.

Depending on your unique situation, you can visit toward the end of your pregnancy or start communicating with a consultant while pregnant to discuss when to schedule a session. They’ll likely suggest an appointment during your first few days/week postpartum. It often works well to contact an LC soon after giving birth, when you know the day of hospital discharge and have your baby’s first pediatric appointment scheduled (that usually happens one to two days after discharge).

What types of certifications are important?

You’ll want to look for an IBCLC (International Board Certified Lactation Consultants) — this is the only standardized, board-certified lactation credential available. Rigorous, defined eligibility requirements must be met in order to take the certification exam conducted twice a year by the International Board of Lactation Consultant Examiners®. 

Every IBCLC around the world must meet the same criteria to take the exam — classroom-style instruction and 1000 hours of supervised clinical work. IBCLCs must re-certify every five years and adhere to the IBCLC Code of Professional Conduct and Scope of Standards of Practice. 

Do lactation consultants take insurance?

It depends. If you are seeing a lactation consultant through your hospital/doctor’s office, they’ll typically take care of billing your insurance, or they may offer this service as a courtesy to all patients who deliver at their hospital.

Many lactation consultants outside of this setting will bill some insurances or provide a superbill that you can submit on your own for the possibility of reimbursement. All insurance companies are supposed to cover lactation services at 100%, as mandated by the Affordable Care Act (ACA), but you should discuss it with your insurance provider.