What to Expect When Working With a Lactation Consultant

Breastfeeding can be challenging, whether this is your first baby or your fourth, and lactation specialists can provide vital support along the way. As with any other healthcare professional, you have ways to make sure you're getting everything you need from a lactation consultant if you are experiencing challenges with breastfeeding.

Here's what you need to know about how to work effectively with your lactation professional.

Types of lactation advisors

In the United States, there are three main types of advisors who can attend to your breastfeeding needs:

• International board-certified lactation consultants (I.B.C.L.C.), certified and registered by the International Board of Lactation Consultant Examiners (IBLCE)
• Lactation counselors or specialists
• Community educators

More than half of the world's IBLCE-registered consultants are in the United States: 18,503 out of 34,069, according to the IBLCE.

What are the differences?

Ruth Hale, I.B.C.L.C., a doula and the owner of Birth to Breast in San Diego, explained the key differences:

• Someone certified as an I.B.C.L.C. has 90 hours of lactation-specific education and 300 to 1,000 clinic hours performed under supervision.
• Lactation counselors or specialists have 45 hours of education.
• Community or lactation educators have undertaken 20 hours of education and may have personal breastfeeding experience. Typically, peer counselors run nonprofit support groups or work for government agencies.

IBLCE-certified lactation consultants are "highly experienced practitioners who are knowledgeable in all areas of lactation, including complex feeding issues," explained Mhairi Higgins, I.B.C.L.C., a certified lactation consultant in Scotland who works for Naytal, a virtual women's health clinic.

Higgins added that recertification is required every five years in order to stay up to date with the latest practices. The I.B.C.L.C. qualification is an internationally recognized certification with a specific code of conduct. Parents can access trained lactation consultants who follow the same best practices and procedures all over the world.

How do lactation consultants help?

Hale explained that lactation consultants can help with three main issues:

1. Checking if your baby is getting the necessary milk
2. Making breastfeeding more comfortable
3. Assisting with breast milk production

This work includes looking at the latch, positioning and flange size for breast pumping.

There are also lesser-known ways a lactation professional can help your breastfeeding experience, including:

• Assessing oral function
• Helping with bottle feeding
• Weaning guidance
• Inducing lactation
• Analyzing medicine safety while breastfeeding

What to expect from a consultant

In terms of appointment logistics, Higgins feels it's possible to work effectively with a consultant face to face or over a video call. She described working with a lactation consultant as a special relationship and said communication is essential.

If necessary, parents can expect a practitioner to stay in touch and develop a plan for their feeding journey. This plan can include formula supplementation, a supplemental feeding system (also known as a supplemental nursing system) or a blood test referral to help determine why there might be insufficient milk supply.

In order to prepare for a lactation consultation, Higgins recommended women do the following:

• Have a partner or friend present to help or support
• Have the baby ready to feed so the consultant can make an assessment
• Film a feeding beforehand
• Bring a list of topics to discuss

Lactation consultants generally have a standardized education, but their approaches can differ depending on the demographic with which they work.

"A lactation consultant who works in the neonatal intensive care unit will have a different view of lactation to someone who works with a birth center or home birth population," Hale explained.

She added that training can be provided by private companies and universities with different continuing education programs, which can account for some differences between lactation advisors in the U.S.

However, Higgins pointed out that IBLCE-registered consultants worldwide receive a standardized education and should be giving similar advice to the breastfeeding family.

When to start

Hale suggested breastfeeding support can begin before the baby is born, with a prenatal appointment after 37 weeks of pregnancy, if possible. Then schedule another appointment two to four days after the baby is born, once you start producing milk.

"I believe four to six well-timed visits are enough for most parents to meet their feeding goals," Hale said.

Higgins has found one consultation can be sufficient in some instances but agreed that follow-up meetings can be useful for more complex feeding issues. She recommended additional appointments in the following instances:

• Nipple damage
• Slow weight gain
• Premature delivery
• Tongue-tie and after a tongue-tie procedure
• Low milk supply

One of the benefits of having follow-up consultations is that they can put your mind at rest if you have other concerns that come up.

"Many clients feel reassured knowing they have an upcoming appointment," Higgins said.

In conclusion

If you are nervous about an upcoming consultation or about speaking to a lactation specialist in general, Higgins recommended having a chat on the phone first to get an idea of what you will need and what you will get out of the session.

"I reassure the client that I will support her any way she wants and find out what she expects from the consultation," she said.

"A lactation consultant is there to listen to you, support you and help you come up with a plan you feel confident in," Hale added.

If you don't feel confident for any reason, then it's OK to get a second opinion.

To find an I.B.C.L.C. in your area, you can search the directories available from the Lactation Network, the International Lactation Consultant Association or the United States Lactation Consultant Association.