When I was pregnant with my first child, I knew I wanted to breastfeed. Since I didn’t know what a breastfeeding journey would look like and didn’t have any family or friends with breastfeeding experience I could turn to for support, I attended a breastfeeding class. 

That’s where I learned about International Board Certified Lactation Consultants (IBCLCs) and how they could help me on my journey.

An IBCLC is a lactation specialist who has received IBCLC certification from the International Board of Lactation Consultant Examiners (IBLCE). As a member of the maternal-child health care team, a lactation consultant specializes in the clinical management of breastfeeding and human lactation, providing families with the care and support needed to reach their breastfeeding goals.

IBCLCs and lactation counselors practice in a variety of settings* including private practices, hospitals, pediatric offices, dental offices, chiropractic offices, milk banks, insurance companies, and telehealth platforms, which have become increasingly popular over the last few months as people seek the care they need without leaving the safety of their homes. You can work with an IBCLC at any point in your pregnancy and lactation journey.

All lactation consultants practice slightly differently, and each consultation is unique, but here are some things you can expect during an initial consultation or visit with an IBCLC:

Paperwork

Paperwork may be related to personal information, hospital/clinic policies, HIPAA disclosures, insurance information, payment policies, health history, etc.  

Payment

Some IBCLCs work directly with specific insurances, some provide superbills so you can be reimbursed by your insurance, and some are self-pay only. Before your consultation, ask the IBCLC what methods of payment they accept and if they work with any insurance companies.

Most private-practice IBCLCs collect payment at the time of their services. The cost varies widely throughout the country and may even vary based on the type of consultation.  

Health History

In order to get an understanding of everything going on within your breastfeeding relationship, the IBCLC will take a full health history for you and your baby. This may include menstrual cycles, pregnancies and births, surgeries, current medications, fertility struggles, your baby’s birth weight and growth, etc.

Address Concerns and Goals

It’s important the IBCLC understands the reason for your visit and what concerns and goals you have. You might want prenatal breastfeeding education; tips for initiating breastfeeding; a latch assessment; or assistance with increasing milk supply, pumping and returning to work, or weaning. Once the IBCLC knows your concerns, they can work with you to establish a plan of care that works for your family.

Weighted Feed

A weighted feed will likely take place if you have any concerns about your baby’s weight gain. In order to perform a weighted feed, your baby will be placed on a scale with only a clean, dry diaper on. You will then nurse, after which your baby will be reweighed using the same scale with the same diaper on. This will allow the lactation consultant to see how much milk was transferred during the feeding.

If your consultation is virtual, the lactation consultant may provide you with ideas for how to track your baby’s weight. For example, they may ask you to make weight-check appointments with your pediatrician, or they may advise you to buy, rent, or borrow a baby scale to help with tracking. 

Breast Examination

During this step, the IBCLC will observe things such as breast and nipple size and shape, lesions on the breast or nipple, and visible scars from surgeries or injuries that could affect the breastfeeding relationship.

Latch and Feeding Analysis

The IBCLC will carefully observe your baby latch onto your breast and begin to suckle. This step is especially important if you have complaints of sore nipples or lesions or notice your baby has a shallow latch.

If you’re having a telehealth appointment, your lactation consultant will instruct you on proper lighting and camera positioning to help make the most of your visit. They may even have you film your baby latching so they can slow the replay down to help with the assessment.

The IBCLC will assess the process of latching on, the angle of your baby’s mouth, tongue movement during latch, and placement once on the breast. Once your baby is latched, the IBCLC will observe and listen for sucking and swallowing.

Feeding Assistance

There are many ways to provide breast milk to your baby. An IBCLC can provide assistance with breast pumps, nipple shields, at-the-breast supplementers (like a supplemental nursing system [SNS] or Lact-Aid), donor milk, and proper formula supplementation if needed.

Establish a Breastfeeding Plan

After the assessment, the IBCLC will work with you to establish a plan of care to help you meet your goals. The IBCLC will verbally go over this lactation care plan with you and may also give written instructions. This care plan can be sent to your baby’s pediatrician and your OBGYN.

Questions

During your visit, there should be plenty of time to ask questions. No question is too small. You may even want to write down questions as you think of them prior to your consultation. The IBCLC is there to address any and all concerns and to explain things in a way you’ll understand.  

If you don’t fully understand something, ask for a different explanation or a visual demonstration. It can even be beneficial to bring along a support person who may provide a fresh viewpoint and help you remember instructions after the consultation.  

Counseling

Another essential service IBCLCs provide is counseling. Many parents benefit from lactation consultants with counseling skills who can provide guidance, encouragement, assistance, and a listening ear.  

For example, an IBCLC may be on the front lines of helping a mother talk through her feelings and recognize any postpartum-related mood symptoms. The IBCLC can then encourage the mom to seek the appropriate care by counseling her to make an appointment with her OBGYN or another health care provider. 

Charting

Proper charting facilitates continuity of care with your IBCLC and other health professionals. There are many charting methods, and the type of charting system used may be a personal choice for the private-practice IBCLC or a company-wide choice for those in a hospital or clinic setting.

IBCLCs are an important part of your health care team. They help to educate, encourage, and empower families through breastfeeding support that respects each family’s feeding choices. I hope this information helps ease any anxiety you may have about reaching out to a lactation consultant.  

To find a lactation consultant in your area, visit USLCA. Be sure to also check your hospital or birth center to see if they offer breastfeeding support groups.

*During the Covid-19 pandemic, both United States lactation consultants and international lactation consultants may be practicing differently. Many are practicing virtually to help ensure breastfeeding mothers are supported during this time.  

While some facilities are limiting outpatient consults, others are using enhanced precautionary measures. Call your IBCLC to find out if they are seeing in-person clients or if a virtual visit is an option.

Some areas also have additional public health initiatives, like breastfeeding hotlines staffed by lactation consultants who provide over-the-phone care.