What is a Lactation Consultant?

BY BOOBER

What’s a Lactation Consultant? How do I know if I need one? And what are all those letters I see? The birth of a new baby is such an exciting, magical time but can also be overwhelming for new parents. No matter how much research you do beforehand or how many newborn care classes you take, you still can’t fully prepare for the experience of being a new parent.  Breastfeeding is often one of the most overwhelming aspects of caring for a newborn. Most new parents worry whether or not their baby is getting enough milk, wonder if they are “doing it right”, may be experiencing pain and nipple damage, and may even be dealing with uninformed pressure from their hospital staff, pediatricians, or family members to supplement with formula, without ever having received in-person breastfeeding help. You may find yourself introduced to a whole slew of new words and terminology you never heard before and wish there was someone who could help you navigate this new territory. Luckily, there is! If you have done your research or have friends who have breastfed you may have heard the various terms for different kinds of people who help with breastfeeding like “IBCLC” with all its many letters and CLC and CBC and CLEC and well, the list goes on!

International Board Certified Lactation Consultants or IBCLCs (called Level 2 at boober to simplify it) are important but often overlooked members of the team of health professionals overseeing the health and well being of a newborn baby and their breastfeeding parent. An IBCLC is certified by the IBLCE and is independently accredited by the National Commission for Certifying Agencies (NCCA) of the Institute for Credentialing Excellence (ICE). IBCLCs are only licensed in two states, so outside of GA and RI anyone can technically use the term “lactation consultant” and not hold the highest-level certification of IBCLC.  Becoming an IBCLC is no easy task! An IBCLC may already have a background as a nurse or other health professional; otherwise, they are required to take college-level coursework in Health Sciences in addition to 90 hours of lactation education and up to 1000 clinical hours working with breastfeeding families. They also sit for a rigorous exam and adhere to a code of professional conduct that governs the profession. IBCLC’s are experts in the clinical management of lactation and breastfeeding and generally have relationships with other healthcare providers in their community like pediatricians, ENT’s, pediatric dentists and other complementary bodywork therapists (craniosacral therapists, osteopaths, chiropractors, acupuncturists, etc.) who all support babies with feeding issues. They work as educators, advocates, policy-makers, collaborators and investigators, all in the name of improving health outcomes for children by supporting and caring for the breastfeeding dyad. IBCLC’s are very commonly confused with the very important, but significantly less trained CLC’s who are Certified Lactation Counselors (called Level 1 at boober).

Studies have shown that close to 83% of new parents in the US start out breastfeeding, but many stop sooner than the exclusive 6 months recommended by the American Academy of Pediatrics. The AAP recommends that babies continue to be breastfed for a year or as long as is “mutually desired by mother and infant.” The AAP affirms that the decision to breastfeed is a public health issue rather than just a lifestyle choice (though we fully support all parents and their personal feeding choices) and mandates that pediatricians should be prepared to support and manage breastfeeding, but many people find their pediatrician is not equipped to help when issues arise. Many new parents find themselves unsure where to turn for help and ultimately give up breastfeeding due to a lack of the care and support needed to continue when a lactating parent is having problems. This is where a lactation consultant or lactation counselor steps in and why the profession is absolutely critical to improving breastfeeding outcomes in our country.

Working with a lactation professional is not just for people struggling with serious issues and shouldn’t be seen as a luxury. In fact, the Affordable Care Act (ACA) requires that lactation counseling be covered and if your insurance company doesn’t have in-network providers they must provide you an out-of-network option (often called an out-of-network exception or geographic gap exception) for reimbursement.  Call your insurance company ahead of time if you can, to navigate this before you have the baby! Here’s a great breastfeeding toolkit from the National Women’s Law Center on getting these invaluable services covered

Although breastfeeding is a natural process, it does not come naturally to everyone. Having a support system in place when you are beginning to breastfeed, in the first few hours or days of your baby's life to ensure that everything is off to a smooth start can make a world of difference in helping a parent meet their breastfeeding goals. Lactation Counselors (remember, that’s Level 1 at boober) are great for the early days, and for those parents who need basic support with breastfeeding they can also act as a “triage” and help refer you to an IBCLC if more targeted intervention is needed. IBCLC’s can assess a baby’s latch, help you find comfortable and effective positions, use a sensitive scale to perform a pre and post-feed weight check to see how much milk a baby receives during a feeding (known as milk transfer), and can examine the babies mouth for any anatomical or structural anomalies that may cause pain, poor milk transfer or other issues for the baby or parent.

Curious if you should seek help from a lactation professional? Here’s some of the differences between Level 1 (Lactation Counselors) and Level 2 (IBCLCs).

Level 1 provider or Lactation Counselor might be suggested if baby is eliminating and gaining well and:

• You have just given birth and are wanting to get your chestfeeding/breastfeeding/pumping/bottlefeeding off to a good start
• Your baby is having mild trouble latching on
• You have been breastfeeding for a while and you could use a little fine-tuning
• You’re not quite sure if your positioning is right or your latch is deep enough and you just want a second set of eyes and some reassurance
• You are experiencing mild pain during the latch or while nursing
• You are returning to work and want help with planning how to keep your milk supply up and finding a pumping and feeding schedule that will work for you.
• Something in your chestfeeding/breastfeeding/pumping/bottlefeeding experience just doesn’t seem right.
• You are looking for support around weaning

Level 2 provider, IBCLCs might be suggested if

• You have pain while breastfeeding
• Your baby isn’t gaining enough weight or has lost weight as per the hospital or pediatrician
• Your nipples are sore, cracked, bleeding or misshapen
• Your baby is having trouble latching on, staying on, or hasn’t latched at all
• Your baby slips off the nipple often or makes clicking sounds while they are feeding
• Your baby does not seem satisfied after a feeding or falls asleep at the beginning of a feeding and wakes up shortly, hungry again
• Your baby has been diagnosed with reflux or food sensitivities/allergies
• Your pediatrician or hospital staff mentioned a possible tongue tie or Tethered Oral Tissues
• You are experiencing frequent clogged ducts or mastitis
• Something in your chestfeeding/breastfeeding/pumping/bottlefeeding experience just doesn’t seem right.

In reality, you don’t have to have any major concerns or issues to seek support and guidance from a Lactation Consultant. Even just validation that you are on the right track and are doing a great job can be life-giving to a new parent and sometimes a little validation is all you need. In this case, dropping in at a local Lactation Support Group near you is a great way to have a weighted feed and meet other lactating parents in your community!